Real-world effectiveness of early molnupiravir or nirmatrelvir–ritonavir in hospitalised patients with COVID-19 without supplemental oxygen requirement on admission during Hong Kong's omicron BA.2 wave: a retrospective cohort study

Wong et al., The Lancet Infectious Diseases, doi:10.1016/S1473-3099(22)00507-2 (date from preprint)

May 2022

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PSM retrospective 40,776 patients in Hong Kong, showing lower mortality and lower combined mortality, ventilation, ICU, and oxygen therapy with paxlovid treatment.

Confounding by contraindication. Hoertel et al. find that over 50% of patients that died had a contraindication for the use of Paxlovid Hoertel. 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" FDA.

1. FDA, Fact sheet for healthcare providers: emergency use authorization for paxlovid, www.fda.gov/media/155050/download.fda.gov.

2. Hoertel et al., Prevalence of Contraindications to Nirmatrelvir-Ritonavir Among Hospitalized Patients With COVID-19 at Risk for Progression to Severe Disease, JAMA Network Open, doi:10.1001/jamanetworkopen.2022.42140.jamanetwork.com, doi.org.

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This study includes paxlovid and molnupiravir.

risk of death, 66.0% lower, HR 0.34, p < 0.001, treatment 890, control 890, propensity score matching.

risk of mechanical ventilation, 3.0% lower, HR 0.97, p = 0.96, treatment 890, control 890, propensity score matching.

combined death/ventilation/ICU/oxygen, 43.0% lower, HR 0.57, p < 0.001, treatment 890, control 890, propensity score matching.

hospitalization time, 4.3% lower, relative time 0.96, p = 0.32, treatment 890, control 890, propensity score matching.

Ct<30, 27.5% lower, HR 0.72, p = 0.01, treatment 890, control 890, inverted to make HR<1 favor treatment, propensity score matching.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

Wong et al., 20 May 2022, retrospective, China, peer-reviewed, 6 authors, study period 26 February, 2022 - 26 April, 2022.

Contact: carlosho@hku.hk, bcowling@hku.hk.

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