A recent study published in JAMA Network Open examined the efficacy of nirmatrelvir-ritonavir and molnupiravir in non-hospitalized patients with coronavirus disease 2019 (COVID-19) and kind 2 diabetes.

Type 2 diabetes is one in every of the common comorbid conditions in COVID-19 patients and has been established as a determinant of clinical prognosis. Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines are effective against severe illness, diabetic patients may mount an inadequate response to vaccination. Subsequently, effective antiviral therapeutics are obligatory to mitigate adversarial disease outcomes in type 2 diabetes patients with COVID-19.

Nirmatrelvir-ritonavir and molnupiravir are oral antivirals approved for non-hospitalized individuals with mild or moderate COVID-19, that are indicated for patients with risk aspects for severe disease progression. Several pathophysiologic mechanisms in type 2 diabetes patients will be chargeable for adversarial COVID-19 outcomes. Further, anti-diabetic medications needs to be tested for effects on COVID-19 outcomes and could possibly be considered when assessing antivirals in these patients.

Study: Evaluation of All-Cause Hospitalization and Death Amongst Nonhospitalized Patients With Type 2 Diabetes and SARS-CoV-2 Infection Treated With Molnupiravir or Nirmatrelvir-Ritonavir Throughout the Omicron Wave in Hong Kong. Image Credit: andrekoehn / Shutterstock

In regards to the study

In the current study, researchers investigated the effectiveness of nirmatrelvir-ritonavir and molnupiravir in a population-based cohort of non-hospitalized type 2 diabetes patients infected with SARS-CoV-2 in the course of the Omicron period in Hong Kong. They included type 2 diabetes patients with COVID-19 between February and October 2022.

SARS-CoV-2 infection was confirmed by a positive rapid antigen or reverse-transcription polymerase chain response (RT-PCR) test result. Antivirals were really helpful for patients aged 60 or older with mild symptoms and risk aspects for severe disease inside five days of symptom onset. Patients received either nirmatrelvir-ritonavir or molnupiravir.

The date of symptom onset or positive test result was defined because the index date. Controls were patients not receiving the required antivirals. Subjects were followed up until consequence occurrence, a crossover of antiviral treatments, death, or the completion of the observational period, whichever was earlier.  

Data on baseline characteristics, resembling sex, age, vaccination status, comorbidities, and the date of infection, were obtained. The study’s outcomes were all-cause hospitalization or mortality and disease progression. Antiviral-treated patients and controls were propensity-score matched based on sex, age, Charlson comorbidity index, medication use, vaccination status, and pre-existing conditions.

Cox regression was used to estimate outcomes between antiviral-treated patients and controls. Sub-group analyses explored interactions by sex, age, vaccination status, baseline insulin usage, and the presence of diabetic complications or kidney disease. Moreover, the team carried out several sensitivity analyses.

Findings

The study included two groups of patients – 921 molnupiravir recipients matched to 921 controls and 793 patients who received nirmatrelvir-ritonavir matched to 793 controls. Most patients were aged 65 or older. A majority of patients followed the really helpful five-day antiviral treatment regimen. Hypertension was essentially the most common comorbidity. No patient had a previous diagnosis of COVID-19.

As much as 37% of patients used insulin, and nearly 30% had diabetic complications. Baseline characteristics were well-balanced after matching. Molnupiravir recipients were more prone to be older, insulin users, had more comorbidities and diabetic complications and were less prone to be vaccinated or boosted.

Nirmatrelvir-ritonavir and molnupiravir recipients were followed up for a median of 85 and 102 days, respectively. Within the molnupiravir group, the cumulative incidence rate of all-cause hospitalization or mortality was 1024.9 and 1952.4 per 100,000 person-days amongst antiviral recipients and matched controls, respectively.

Within the nirmatrelvir-ritonavir group, the cumulative incidence rate was 695.8 and 1131.2 per 100,000 person-days amongst antiviral recipients and matched controls, respectively. Antiviral recipients had lower risks of all-cause hospitalization and mortality than controls. Moreover, only molnupiravir use was significantly related to a lower risk of in-hospital disease progression.

Sub-group analyses yielded results comparable to the first evaluation, regardless of sex, age, insulin usage, and vaccination status. The treatment effect of nirmatrelvir-ritonavir for younger and older age groups was not compared on account of a lower incidence of outcomes in younger patients. All sensitivity analyses reproduced similar findings.

Conclusions

To conclude, the researchers assessed the effectiveness of nirmatrelvir-ritonavir or molnupiravir use amongst type 2 diabetes patients infected with SARS-CoV-2. Antiviral use was related to a 29% decrease in all-cause hospitalization and mortality relative to controls who didn’t receive these antivirals. Furthermore, antiviral treatment reduced the chance of in-hospital progression to severe illness, albeit nirmatrelvir-ritonavir use didn’t reach statistical significance. Overall, the findings corroborate the effectiveness of those oral antiviral drugs in outpatients.