BMC Infectious Diseases (Oct 2023)

Comparison between available early antiviral treatments in outpatients with SARS-CoV-2 infection: a real-life study

  • Matteo Rinaldi,
  • Caterina Campoli,
  • Mena Gallo,
  • Domenico Marzolla,
  • Alberto Zuppiroli,
  • Riccardo Riccardi,
  • Martina Casarini,
  • Daniele Riccucci,
  • Marta Malosso,
  • Cecilia Bonazzetti,
  • Renato Pascale,
  • Beatrice Tazza,
  • Zeno Pasquini,
  • Lorenzo Marconi,
  • Stefania Curti,
  • Maddalena Giannella,
  • Pierluigi Viale

DOI
https://doi.org/10.1186/s12879-023-08538-9
Journal volume & issue
Vol. 23, no. 1
pp. 1 – 9

Abstract

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Abstract Purpose To investigate the clinical impact of three available antivirals for early COVID-19 treatment in a large real-life cohort. Methods Between January and October 2022 all outpatients tested positive for SARS-CoV-2 referring to IRCCS S. Orsola hospital treated with an early antiviral therapy were enrolled. A comparison between patients treated with nirmatrelvir/ritonavir (NTV/r), molnupiravir (MPV) and remdesivir (RDV) was conducted in term of indications and outcome. To account for differences between treatment groups a propensity score analysis was performed. After estimating the weights, we fitted a survey-weighted Cox regression model with inverse-probability weighting with hospital admission/death versus clinical recovery as the primary outcome. Results Overall 1342 patients were enrolled, 775 (57.8%), 360 (26.8%) and 207 (15.4%) in MPV, NTV/r and RDV group, respectively. Median age was 73 (59–82) years, male sex was 53.4%. Primary indication was immunosuppression (438, 32.6%), the median time from symptom onset to drug administration was 3 [2–4] days. Overall, clinical recovery was reached in 96.9% of patients, with hospital admission rate of 2.6%. No significant differences were found in clinical recovery nor hospitalization. Cox regression showed a decreased probability of hospital admission/ death among prior vaccinated patients compared with unvaccinated (HR 0.31 [95%CI 0.14–0.70], p = 0.005]). No difference in hospitalization rates in early treatment compared to late treatment were found. Conclusions No differences among MPV, NTV/r and RDV in terms of clinical recovery or hospitalization were found. Patients not vaccinated had a significant increased risk of hospitalization.

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