When given early, the antiviral drug molnupiravir (Lagevrio) halved the risk of COVID-19 death and reduced all-cause deaths among older adults in the Czech Republic in 2022, findings published yesterday in Open Forum Infectious Diseases suggest.
Masaryk University researchers analyzed data from all 74,541 adults with a diagnosis of COVID-19 in the national registry infection treated with molnupiravir from January through December 2022, a period dominated by the SARS-CoV-2 Omicron variant. A control group consisted of 1.5 million matched COVID-19 patients not receiving the drug. Follow-up was 1 year.
Patients were eligible for molnupiravir if they were at risk for severe illness (age older than 65 years, being obese, or having underlying illnesses), had mild symptoms, and were within 7 days of a positive COVID-19 test. Average patient age was 56.7 years, and 73% were fully vaccinated against the virus.
Early antiviral initiation crucial
The cumulative incidence of 30-day all-cause mortality was 0.76% in molnupiravir recipients and 1.18% in controls (absolute risk difference, -0.42 percentage points). The antiviral was also tied to a lower risk of both 30-day COVID-19 death (adjusted hazard ratio [aHR], 0.50) and all-cause death (aHR, 0.58).
Molnupiravir was effective regardless of sex, DCCI score [which measures comorbidities], age in patients over 65 years, hospitalisation status, and COVID-19 vaccination status.
The drug's effect was highly significant in participants older than 65 years. No benefit was seen among younger patients or those who started molnupiravir 4 to 7 days after diagnosis.
Molnupiravir was linked to a significantly lower risk of COVID-19 death (cumulative incidence, 0.28% in drug recipients and 0.48% in controls [absolute risk difference, -0.20 percentage points]). The greatest risk reductions in COVID-19 and all-cause deaths were seen among women and hospitalized patients.
"In subgroup analyses, we found no significant interaction between molnupiravir treatment and vaccination status for either outcome, suggesting no reduction in the effectiveness of molnupiravir with respect to vaccination," the study authors wrote.
Patients with kidney disease or moderate or severe liver disease had triple the rate of all-cause death than the entire cohort; the cumulative incidence of all-cause death was 2.30% in molnupiravir recipients and 3.96% in controls (absolute risk difference, -1.66 percentage points). In these patients, molnupiravir significantly lowered the risk of both all-cause and COVID-19 death (aHR, 0.58).
"Early initiation of molnupiravir was associated with a significant reduction in both 30-day all-cause mortality and COVID-19-related mortality in adult patients with an officially reported SARS-CoV-2 positivity," the researchers wrote. "In addition, molnupiravir was effective regardless of sex, DCCI score [which measures comorbidities], age in patients over 65 years, hospitalisation status, and COVID-19 vaccination status."
