Treatment outcomes and factors associated with treatment failure among patients with mild-to-moderate COVID-19 receiving five-days of oral molnupiravir vs. three-days of intravenous remdesivir in a real-world practice

Sarawut  Kittikasemsook; Pattama  Torvorapanit; Chotirat  Nakaranurack

Authors

Sarawut Kittikasemsook King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
Pattama Torvorapanit Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
Chotirat Nakaranurack Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand

Keywords:

COVID-19, factors, molnupiravir, three-day intravenous remdesivir, treatment outcomes

Abstract

Background: The initiation of antiviral treatment for coronavirus disease 2019 (COVID-19) is based on the patient’s risk of developing severe symptoms. Molnupiravir and remdesivir are new antiviral agents with limited data in real-world practice, especially in Thailand.

Objectives: This study aimed to evaluate the treatment outcomes, adverse drug reactions (ADRs), and factors associated with treatment failure in adults with mild-to-moderate symptoms of COVID-19 who received five days of oral molnupiravir or three days of intravenous remdesivir at treatment initiation.

Methods: This retrospective study was conducted at King Chulalongkorn Memorial Hospital, Thai Red Cross Society. The inclusion criteria were patients 18 years or older with mild-to-moderate symptoms of COVID-19 who were treated during April 2022 and received five days of oral molnupiravir or three days of intravenous remdesivir at treatment initiation. Factors associated with treatment failure were analyzed by logistic regression with statistical significance at P < 0.05.

Results: Of the 182 included patients, 105 (57.7%) received remdesivir and 77 (42.3%) received molnupiravir. Treatment failure between the six cases (7.8%) of the molnupiravir group and 24 cases (22.9%) of the remdesivir group was statistically significant (P = 0.007). By day 10, 30 patients (39.0%) in the molnupiravir group and 75 patients (71.4%) in the remdesivir group had clinically resolved (P < 0.001). Male gender (adjusted odds ratio = 3.375) and pneumonia (adjusted odds ratio = 2.495) were associated with treatment failure. No deaths or rehospitalizations within 30 days after antiviral therapy were observed in this study. The recorded ADRs included headaches or dizziness with remdesivir (3.8%) and diarrhea with molnupiravir (5.2%).

Conclusion: Oral molnupiravir for five days and three days of intravenous remdesivir are still recommended treatments for patients with mild-to-moderate COVID-19 at risk of developing severe symptoms. Both antiviral agents are safe with few and mild ADRs. This study suggests closely monitoring patients with COVID-19 and pneumonia.

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