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Clinical Outcomes Following Treatment for COVID-19 With Nirmatrelvir/Ritonavir and Molnupiravir Among Patients Living in Nursing Homes

IMPORTANCE: Older patients living in nursing homes are at very high risk of mortality after getting COVID-19. OBJECTIVE: To evaluate outcomes following oral antiviral treatment for COVID-19 among nonhospitalized older patients living in nursing homes. DESIGN, SETTING, AND PARTICIPANTS: This is a ter...

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Autores principales: Ma, Bosco Hon-Ming, Yip, Terry Cheuk-Fung, Lui, Grace Chung-Yan, Lai, Mandy Sze-Man, Hui, Elsie, Wong, Vincent Wai-Sun, Tse, Yee-Kit, Chan, Henry Lik-Yuen, Hui, David Shu-Cheong, Kwok, Timothy Chi-Yui, Wong, Grace Lai-Hung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10140804/
https://www.ncbi.nlm.nih.gov/pubmed/37103932
http://dx.doi.org/10.1001/jamanetworkopen.2023.10887
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author Ma, Bosco Hon-Ming
Yip, Terry Cheuk-Fung
Lui, Grace Chung-Yan
Lai, Mandy Sze-Man
Hui, Elsie
Wong, Vincent Wai-Sun
Tse, Yee-Kit
Chan, Henry Lik-Yuen
Hui, David Shu-Cheong
Kwok, Timothy Chi-Yui
Wong, Grace Lai-Hung
author_facet Ma, Bosco Hon-Ming
Yip, Terry Cheuk-Fung
Lui, Grace Chung-Yan
Lai, Mandy Sze-Man
Hui, Elsie
Wong, Vincent Wai-Sun
Tse, Yee-Kit
Chan, Henry Lik-Yuen
Hui, David Shu-Cheong
Kwok, Timothy Chi-Yui
Wong, Grace Lai-Hung
author_sort Ma, Bosco Hon-Ming
collection PubMed
description IMPORTANCE: Older patients living in nursing homes are at very high risk of mortality after getting COVID-19. OBJECTIVE: To evaluate outcomes following oral antiviral treatment for COVID-19 among nonhospitalized older patients living in nursing homes. DESIGN, SETTING, AND PARTICIPANTS: This is a territory-wide, retrospective cohort study conducted between February 16 and March 31, 2022, with the last follow-up date on April 25, 2022. Participants were patients with COVID-19 living in nursing homes in Hong Kong. Data analysis was performed from May to June 2022. EXPOSURES: Molnupiravir, nirmatrelvir/ritonavir, or no oral antiviral treatment. MAIN OUTCOMES AND MEASURES: The primary outcome was hospitalization for COVID-19, and the secondary outcome was risk of inpatient disease progression (ie, admission to intensive care unit, use of invasive mechanical ventilation, and/or death). RESULTS: Of 14 617 patients (mean [SD] age, 84.8 [10.2] years; 8222 women [56.2%]), 8939 (61.2%) did not use oral antivirals, 5195 (35.5%) used molnupiravir, and 483 (3.3%) used nirmatrelvir/ritonavir. Compared with patients who did not use oral antivirals, those who used molnupiravir and nirmatrelvir/ritonavir were more likely to be female and less likely to have comorbid illnesses and hospitalization in the past year. At a median (IQR) follow-up of 30 (30-30) days, 6223 patients (42.6%) were hospitalized and 2307 patients (15.8%) experienced inpatient disease progression. After propensity score weighting, both molnupiravir and nirmatrelvir/ritonavir were associated with a reduced risk of hospitalization (molnupiravir, weighted hazard ratio [wHR], 0.46; 95% CI, 0.37-0.57; P < .001; nirmatrelvir/ritonavir, wHR, 0.46; 95% CI, 0.32-0.65; P < .001) and inpatient disease progression (molnupiravir, wHR, 0.35; 95% CI, 0.23-0.51; P < .001; nirmatrelvir/ritonavir, wHR, 0.17; 95% CI, 0.06-0.44; P < .001). Nirmatrelvir/ritonavir was comparable to molnupiravir in achieving better clinical outcomes (hospitalization, wHR, 1.00; 95% CI, 0.75-1.33; P = .99; inpatient disease progression, wHR, 0.49; 95% CI, 0.20-1.20; P = .12). CONCLUSIONS AND RELEVANCE: In this retrospective cohort study, the use of oral antivirals to treat COVID-19 was associated with a reduced risk of hospitalization and inpatient disease progression among patients living in nursing homes. The findings of this study of nursing home residents could be reasonably extrapolated to other frail older patients living in the community.
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spelling pubmed-101408042023-04-29 Clinical Outcomes Following Treatment for COVID-19 With Nirmatrelvir/Ritonavir and Molnupiravir Among Patients Living in Nursing Homes Ma, Bosco Hon-Ming Yip, Terry Cheuk-Fung Lui, Grace Chung-Yan Lai, Mandy Sze-Man Hui, Elsie Wong, Vincent Wai-Sun Tse, Yee-Kit Chan, Henry Lik-Yuen Hui, David Shu-Cheong Kwok, Timothy Chi-Yui Wong, Grace Lai-Hung JAMA Netw Open Original Investigation IMPORTANCE: Older patients living in nursing homes are at very high risk of mortality after getting COVID-19. OBJECTIVE: To evaluate outcomes following oral antiviral treatment for COVID-19 among nonhospitalized older patients living in nursing homes. DESIGN, SETTING, AND PARTICIPANTS: This is a territory-wide, retrospective cohort study conducted between February 16 and March 31, 2022, with the last follow-up date on April 25, 2022. Participants were patients with COVID-19 living in nursing homes in Hong Kong. Data analysis was performed from May to June 2022. EXPOSURES: Molnupiravir, nirmatrelvir/ritonavir, or no oral antiviral treatment. MAIN OUTCOMES AND MEASURES: The primary outcome was hospitalization for COVID-19, and the secondary outcome was risk of inpatient disease progression (ie, admission to intensive care unit, use of invasive mechanical ventilation, and/or death). RESULTS: Of 14 617 patients (mean [SD] age, 84.8 [10.2] years; 8222 women [56.2%]), 8939 (61.2%) did not use oral antivirals, 5195 (35.5%) used molnupiravir, and 483 (3.3%) used nirmatrelvir/ritonavir. Compared with patients who did not use oral antivirals, those who used molnupiravir and nirmatrelvir/ritonavir were more likely to be female and less likely to have comorbid illnesses and hospitalization in the past year. At a median (IQR) follow-up of 30 (30-30) days, 6223 patients (42.6%) were hospitalized and 2307 patients (15.8%) experienced inpatient disease progression. After propensity score weighting, both molnupiravir and nirmatrelvir/ritonavir were associated with a reduced risk of hospitalization (molnupiravir, weighted hazard ratio [wHR], 0.46; 95% CI, 0.37-0.57; P < .001; nirmatrelvir/ritonavir, wHR, 0.46; 95% CI, 0.32-0.65; P < .001) and inpatient disease progression (molnupiravir, wHR, 0.35; 95% CI, 0.23-0.51; P < .001; nirmatrelvir/ritonavir, wHR, 0.17; 95% CI, 0.06-0.44; P < .001). Nirmatrelvir/ritonavir was comparable to molnupiravir in achieving better clinical outcomes (hospitalization, wHR, 1.00; 95% CI, 0.75-1.33; P = .99; inpatient disease progression, wHR, 0.49; 95% CI, 0.20-1.20; P = .12). CONCLUSIONS AND RELEVANCE: In this retrospective cohort study, the use of oral antivirals to treat COVID-19 was associated with a reduced risk of hospitalization and inpatient disease progression among patients living in nursing homes. The findings of this study of nursing home residents could be reasonably extrapolated to other frail older patients living in the community. American Medical Association 2023-04-27 /pmc/articles/PMC10140804/ /pubmed/37103932 http://dx.doi.org/10.1001/jamanetworkopen.2023.10887 Text en Copyright 2023 Ma BHM et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Ma, Bosco Hon-Ming
Yip, Terry Cheuk-Fung
Lui, Grace Chung-Yan
Lai, Mandy Sze-Man
Hui, Elsie
Wong, Vincent Wai-Sun
Tse, Yee-Kit
Chan, Henry Lik-Yuen
Hui, David Shu-Cheong
Kwok, Timothy Chi-Yui
Wong, Grace Lai-Hung
Clinical Outcomes Following Treatment for COVID-19 With Nirmatrelvir/Ritonavir and Molnupiravir Among Patients Living in Nursing Homes
title Clinical Outcomes Following Treatment for COVID-19 With Nirmatrelvir/Ritonavir and Molnupiravir Among Patients Living in Nursing Homes
title_full Clinical Outcomes Following Treatment for COVID-19 With Nirmatrelvir/Ritonavir and Molnupiravir Among Patients Living in Nursing Homes
title_fullStr Clinical Outcomes Following Treatment for COVID-19 With Nirmatrelvir/Ritonavir and Molnupiravir Among Patients Living in Nursing Homes
title_full_unstemmed Clinical Outcomes Following Treatment for COVID-19 With Nirmatrelvir/Ritonavir and Molnupiravir Among Patients Living in Nursing Homes
title_short Clinical Outcomes Following Treatment for COVID-19 With Nirmatrelvir/Ritonavir and Molnupiravir Among Patients Living in Nursing Homes
title_sort clinical outcomes following treatment for covid-19 with nirmatrelvir/ritonavir and molnupiravir among patients living in nursing homes
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10140804/
https://www.ncbi.nlm.nih.gov/pubmed/37103932
http://dx.doi.org/10.1001/jamanetworkopen.2023.10887
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