Short- and long-term comparative effectiveness of nirmatrelvir/ritonavir and molnupiravir in asthma patients: a cohort study

BackgroundFew studies evaluated the effectiveness of COVID-19 antivirals specifically in the asthma population This study assessed short- and long-term effects of nirmatrelvir/ritonavir versus molnupiravir in asthma population.MethodsThis is a retrospective cohort study on adult asthma patients infected with COVID-19, using real-world data obtained from the health officials in Hong Kong. Key inclusion criteria were infection with COVID-19 between March 16, 2022, and Oct 30, 2023, age >= 18 years, previous asthma diagnosis, and prescription history of an asthma medication. Outcomes included acute and post-acute mortality, post-acute all-cause hospitalization, and cause-specific hospitalization.Results1,745 patients were eligible for this study, with a median follow-up time of 365 days (IQR: 335-365). Patients in the nirmatrelvir/ritonavir group had significantly lower risks of acute inpatient death (HR, 0<middle dot>27 [95% CI, 0<middle dot>12 to 0<middle dot>59]; p = 0<middle dot>0011), post-acute inpatient death (HR, 0<middle dot>49 [95% CI, 0<middle dot>28 to 0<middle dot>85]; p = 0<middle dot>011), all-cause hospitalization (HR, 0<middle dot>72 [95% CI, 0<middle dot>58 to 0<middle dot>89]; p = 0<middle dot>0020), and myocardial infarction (HR, 0<middle dot>10 [95% CI, 0<middle dot>01 to 0<middle dot>92]; p = 0<middle dot>042) than patients in the control group. The risk of all-cause hospitalization was significantly lower in the nirmatrelvir/ritonavir group compared to the molnupiravir group (HR, 0<middle dot>65 [95% CI, 0<middle dot>52 to 0<middle dot>81]; p = 0<middle dot>00012). Among patients who were prescribed medium-/ high-dose inhaled corticosteroids, the nirmatrelvir/ritonavir group had a lower hazard of asthma exacerbation than the molnupiravir group (HR, 0<middle dot>58 [95% CI, 0<middle dot>35 to 0<middle dot>95]; p = 0.030).ConclusionCompared with molnupiravir, nirmatrelvir/ritonavir may offer more benefits in reducing the risk of post-acute sequelae of COVID-19 among asthma patients. In addition, the post-acute benefits of the antivirals were also demonstrated in patients with mild asthma, which have not been generally recommended in existing clinical management guidelines.