Molnupiravir for high-risk adults with COVID-19: Target trial emulation in a Japanese cohort.

IF 1.9 4区医学 Q3 INFECTIOUS DISEASES

Journal of Infection and Chemotherapy Pub Date : 2024-12-12 DOI:10.1016/j.jiac.2024.12.016

Yuya Kimura, Hiroki Matsui, Sachiko Ono, So Sato, Hideo Yasunaga

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引用次数: 0

Abstract

Background: Evidence on the effectiveness of molnupiravir for high-risk adults in a highly vaccinated Asian population is sparse. In this study, we aimed to estimate the association between molnupiravir use and hospital admission or death in high-risk adults with COVID-19 during the Omicron era.

Methods: This retrospective cohort study included high-risk patients diagnosed with COVID-19 in Shimonoseki City between September 16, 2022, and May 8, 2023. The outcome was a composite of hospital admission or death within 28 days. Participants were categorized into two groups: those who used molnupiravir within 5 days of diagnosis and those who did not. The outcomes were compared using a Cox proportional hazards model. Treatment weighting was used to balance patient backgrounds between the groups, and the clone method with inverse probability of censoring weighting was used to adjust for informative censoring.

Results: We analyzed 330 patients (190 females, 57.6 %) with a mean age of 68.6 years. The proportion of fully vaccinated and boosted patients was 82.9 % (155/187) in the molnupiravir group and 90.2 % (129/143) in the control group. The overall 28-day incidence of all-cause hospitalization and mortality was 5.2 % (17/330), with 3.2 % (6/187) in the molnupiravir group and 7.7 % (11/143) in the control group. Molnupiravir was associated with a decrease in hospital admissions or death within 28 days (weighted hazard ratio, 0.35 [95 % confidence intervals, 0.13 to 0.90]).

Conclusions: Molnupiravir was linked to fewer hospitalizations or deaths within 28 days compared to no treatment in highly vaccinated high-risk patients with COVID-19 in Japan.

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莫努匹拉韦用于高风险成人COVID-19：日本队列中的目标试验模拟

背景：在高度接种疫苗的亚洲人群中，关于molnupiravir对高危成人有效性的证据很少。在这项研究中，我们的目的是估计在欧米克隆时代，使用莫努匹拉韦与高危成人COVID-19住院或死亡之间的关系。方法：本回顾性队列研究纳入了2022年9月16日至2023年5月8日在马关市诊断为COVID-19的高危患者。结果是28天内住院或死亡的综合结果。参与者被分为两组：在诊断后5天内使用molnupiravir的组和未使用的组。采用Cox比例风险模型对结果进行比较。采用治疗加权法平衡各组患者背景，采用加权逆概率克隆法进行信息筛选。结果：我们分析了330例患者，其中女性190例，占57.6%，平均年龄68.6岁。molnupiravir组完全接种和强化的患者比例为82.9%(155/187)，对照组为90.2%（129/143）。总28天全因住院率和死亡率为5.2%(17/330)，其中莫努比拉韦组3.2%(6/187)，对照组7.7%（11/143）。Molnupiravir与28天内住院率或死亡率的降低相关（加权风险比为0.35[95%可信区间为0.13 ~ 0.90]）。结论：在日本，与未接受治疗的高度接种疫苗的高风险COVID-19患者相比，Molnupiravir与28天内住院或死亡人数减少有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Infection and Chemotherapy INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY

CiteScore

4.10

自引率

4.50%

发文量

303

审稿时长

47 days

期刊介绍： The Journal of Infection and Chemotherapy (JIC) — official journal of the Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases — welcomes original papers, laboratory or clinical, as well as case reports, notes, committee reports, surveillance and guidelines from all parts of the world on all aspects of chemotherapy, covering the pathogenesis, diagnosis, treatment, and control of infection, including treatment with anticancer drugs. Experimental studies on animal models and pharmacokinetics, and reports on epidemiology and clinical trials are particularly welcome.