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Article: Comparing the effectiveness of molnupiravir and nirmatrelvir-ritonavir in non-hospitalized and hospitalized COVID-19 patients with type 2 diabetes: A target trial emulation study
Title | Comparing the effectiveness of molnupiravir and nirmatrelvir-ritonavir in non-hospitalized and hospitalized COVID-19 patients with type 2 diabetes: A target trial emulation study |
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Authors | |
Keywords | effectiveness pharmacoepidemiology real-world evidence type 2 diabetes |
Issue Date | 7-Aug-2024 |
Publisher | Wiley-Blackwell |
Citation | Diabetes, Obesity and Metabolism, 2024, p. 1-12 How to Cite? |
Abstract | Aims: To compare the effectiveness of molnupiravir and nirmatrelvir-ritonavir for non-hospitalized and hospitalized COVID-19 patients with type 2 diabetes (T2DM). Materials and Methods: Territory-wide electronic health records in Hong Kong were used to perform target trial emulation using a sequential trial approach. Patients (1) aged ≥18 years, (2) with T2DM, (3) with COVID-19 infection, and (4) who received molnupiravir or nirmatrelvir-ritonavir within 5 days of infection between 16 March 2022 and 31 December 2022 in non-hospital and hospital settings were included. Molnupiravir and nirmatrelvir-ritonavir initiators were matched using one-to-one propensity-score matching and followed for 28 days. Risk of outcomes was compared between groups by Cox regression adjusted for baseline characteristics. Subgroup analyses were performed on age (<70 years, ≥70 years), sex, Charlson comorbidity index (<4, ≥4), and number of COVID-19 vaccine doses (<2 doses, ≥2 doses). Results: Totals of 17 974 non-hospitalized (8987 in each group) and 3678 hospitalized (1839 in each group) patients were identified. Non-hospitalized nirmatrelvir-ritonavir initiators had lower risk of all-cause mortality (absolute risk reduction [ARR] at 28 days 0.80%, 95% confidence interval [CI] 0.56–1.04; hazard ratio [HR] 0.47, 95% CI 0.30–0.73) and hospitalization (ARR at 28 days 4.01%, 95% CI 3.19–4.83; HR 0.73, 95% CI 0.66–0.82) as compared with molnupiravir initiators. Hospitalized nirmatrelvir-ritonavir initiators had reduced risk of all-cause mortality (ARR at 28 days 2.94%, 95% CI 1.65–4.23; HR 0.56, 95% CI 0.40–0.80) as compared with molnupiravir initiators. Consistent findings were found across all subgroups. Conclusions: The use of nirmatrelvir-ritonavir may be preferred to molnupiravir for COVID-19 patients with T2DM and without contraindication to either treatment. |
Persistent Identifier | http://hdl.handle.net/10722/345730 |
ISSN | 2023 Impact Factor: 5.4 2023 SCImago Journal Rankings: 2.079 |
DC Field | Value | Language |
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dc.contributor.author | Wan, Eric YF | - |
dc.contributor.author | Wong, Zoey CT | - |
dc.contributor.author | Yan, Vincent KC | - |
dc.contributor.author | Chui, Celine SL | - |
dc.contributor.author | Lai, Francisco TT | - |
dc.contributor.author | Li, Xue | - |
dc.contributor.author | Wong, Ian CK | - |
dc.contributor.author | Chan, Esther WY | - |
dc.date.accessioned | 2024-08-27T09:10:48Z | - |
dc.date.available | 2024-08-27T09:10:48Z | - |
dc.date.issued | 2024-08-07 | - |
dc.identifier.citation | Diabetes, Obesity and Metabolism, 2024, p. 1-12 | - |
dc.identifier.issn | 1462-8902 | - |
dc.identifier.uri | http://hdl.handle.net/10722/345730 | - |
dc.description.abstract | <p>Aims: To compare the effectiveness of molnupiravir and nirmatrelvir-ritonavir for non-hospitalized and hospitalized COVID-19 patients with type 2 diabetes (T2DM). Materials and Methods: Territory-wide electronic health records in Hong Kong were used to perform target trial emulation using a sequential trial approach. Patients (1) aged ≥18 years, (2) with T2DM, (3) with COVID-19 infection, and (4) who received molnupiravir or nirmatrelvir-ritonavir within 5 days of infection between 16 March 2022 and 31 December 2022 in non-hospital and hospital settings were included. Molnupiravir and nirmatrelvir-ritonavir initiators were matched using one-to-one propensity-score matching and followed for 28 days. Risk of outcomes was compared between groups by Cox regression adjusted for baseline characteristics. Subgroup analyses were performed on age (<70 years, ≥70 years), sex, Charlson comorbidity index (<4, ≥4), and number of COVID-19 vaccine doses (<2 doses, ≥2 doses). Results: Totals of 17 974 non-hospitalized (8987 in each group) and 3678 hospitalized (1839 in each group) patients were identified. Non-hospitalized nirmatrelvir-ritonavir initiators had lower risk of all-cause mortality (absolute risk reduction [ARR] at 28 days 0.80%, 95% confidence interval [CI] 0.56–1.04; hazard ratio [HR] 0.47, 95% CI 0.30–0.73) and hospitalization (ARR at 28 days 4.01%, 95% CI 3.19–4.83; HR 0.73, 95% CI 0.66–0.82) as compared with molnupiravir initiators. Hospitalized nirmatrelvir-ritonavir initiators had reduced risk of all-cause mortality (ARR at 28 days 2.94%, 95% CI 1.65–4.23; HR 0.56, 95% CI 0.40–0.80) as compared with molnupiravir initiators. Consistent findings were found across all subgroups. Conclusions: The use of nirmatrelvir-ritonavir may be preferred to molnupiravir for COVID-19 patients with T2DM and without contraindication to either treatment.</p> | - |
dc.language | eng | - |
dc.publisher | Wiley-Blackwell | - |
dc.relation.ispartof | Diabetes, Obesity and Metabolism | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.subject | effectiveness | - |
dc.subject | pharmacoepidemiology | - |
dc.subject | real-world evidence | - |
dc.subject | type 2 diabetes | - |
dc.title | Comparing the effectiveness of molnupiravir and nirmatrelvir-ritonavir in non-hospitalized and hospitalized COVID-19 patients with type 2 diabetes: A target trial emulation study | - |
dc.type | Article | - |
dc.description.nature | published_or_final_version | - |
dc.identifier.doi | 10.1111/dom.15830 | - |
dc.identifier.scopus | eid_2-s2.0-85200549223 | - |
dc.identifier.spage | 1 | - |
dc.identifier.epage | 12 | - |
dc.identifier.eissn | 1463-1326 | - |
dc.identifier.issnl | 1462-8902 | - |