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Low antiviral uptake of nirmatrelvir/ritonavir and molnupiravir in adult patients with COVID-19 in Taiwan in 2022

Wang et al., Journal of Global Health, doi:10.7189/jogh.14.05032
Nov 2024  
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Retrospective 96,398 adult COVID-19 patients in Taiwan showing very low use of approved antivirals nirmatrelvir/ritonavir (5.1%) and molnupiravir (1.9%) in 2022, especially in moderate-to-high risk groups eligible for treatment per WHO guidelines. Barriers to use include the requirement for a prescription, time required for assessing drug interactions, perceived risks/benefits, and lack of awareness.
Resistance. Variants may be resistant to paxlovid1-4. Use may promote the emergence of variants that weaken host immunity and potentially contribute to long COVID5.
Confounding by contraindication. Hoertel et al. find that over 50% of patients that died had a contraindication for the use of Paxlovid6. Retrospective studies that do not exclude contraindicated patients may significantly overestimate efficacy.
Black box warning. The FDA notes that "severe, life-threatening, and/or fatal adverse reactions due to drug interactions have been reported in patients treated with paxlovid"7.
AKI. Kamo et al. show significantly increased risk of acute kidney injury.
Study covers molnupiravir and paxlovid.
Wang et al., 8 Nov 2024, retrospective, Taiwan, peer-reviewed, 14 authors, study period January 2022 - December 2022. Contact: jasonhsu@tmu.edu.tw.
This PaperPaxlovidAll
Abstract: Cite as: Wang FD, Nguyen PA, Lee D, Taysi B, Lefebvre d‘Hellencourt F, Spinardi J, Phuc PT, Burton W, Chang YH, Hien NTK, Lin SM, Chieh Y, Kyaw MH, Hsu JC. Low antiviral uptake of nirmatrelvir/ritonavir and molnupiravir in adult patients with COVID-19 in Taiwan in 2022. J Glob Health 2024;14:05032. Low antiviral uptake of nirmatrelvir/ ritonavir and molnupiravir in adult patients with COVID-19 in Taiwan in 2022 Fu-Der Wang1,2, Phung-Anh Nguyen3,4,5,6 , David Lee7, Bulent Taysi8, Florence Lefebvre d’Hellencourt9 , Julia Spinardi9, Phan Thanh Phuc10 , Whitney Burton10, Yu-Hui Chang11, Nguyen Thi Kim Hien12,13, Shiue-Ming Lin6, Yang Chieh6, Moe H Kyaw9 , Jason C Hsu4,5,6,10 Background Antivirals are effective in reducing hospitalisation and death in mild-to-moderate coronavirus 2019 (COVID-19) patients. We estimated the antiviral uptake of nirmatrelvir/ritonavir and molnupiravir in adult patients with a syndrome coronavirus 2 (SARSCoV-2) infection during the Emergency Use Authorization (EUA) period in Taiwan. Division of Infectious Diseases, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan 2 National Yang-Ming Chiao-Tung University, Taipei, Taiwan 3 Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan 4 Clinical Data Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan 5 Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan 6 Research Center of Health Care Industry Data Science, College of Management, Taipei Medical University, Taipei, Taiwan 7 Pfizer, Taipei, Taiwan 8 Pfizer, Singapore 9 Pfizer, New York, USA 10 International PhD Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, Taipei, Taiwan 11 School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan 12 Master Program in Global Health and Development, College of Public Health, Taipei Medical University, Taipei City, Taiwan 13 College of Nutrition, Taipei Medical University, Taipei City, Taiwan Methods A retrospective cohort study was conducted in Taiwan between January 2022 and December 2022. Patients aged ≥18 years with a SARS-CoV-2 infection were included from the Taipei Medical University Clinical Research Database (TMUCRD) and stratified in three risk groups according to World Health Organization criteria. 1 Results In total, 96 398 COVID-19 patients (mean age 46.7 ± 17.7 years, 45.8% male) were included. Of these patients 69.8% were classified as low risk, 29.8% as moderate risk, and 0.4% as high risk for progression to severe COVID-19. Nirmatrelvir/ritonavir was prescribed in 5.1% of the COVID-19 patients (low risk = 1.0%, moderate risk = 14.3%, high risk = 17.6%). Molnupiravir was prescribed in 1.9% of the COVID-19 patients (low risk = 0.1%, moderate risk = 5.8%, high risk = 6.9%). Conclusions Nirmatrelvir/ritonavir and molnupiravir were poorly used in the treatment of adult COVID-19 patients in Taiwan during the pandemic in 2022, especially in moderate-to-high risk groups for progression to severe COVID-19. Since its emergence in December 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), led to significant morbidity and mortality worldwide. As of April 2024, Taiwan had nearly 10 million confirmed cases and 18 thousand deaths due to COVID-19 [1]. Correspondence..
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