A study today in the Canadian Medical Association Journal suggests that use of the oral antiviral drugs molnupiravir and Paxlovid in patients with mild or moderate COVID-19 lowered the risk of hospitalization and death without raising the risk of adverse events.McMaster University researchers in Ontario led the systematic review and network meta-analysis of 40 randomized clinical trials that included 17,563 patients comparing the effectiveness of 16 different antiviral drugs or drug combinations, including molnupiravir, nirmatrelvir-ritonavir (Paxlovid), and remdesivir, with standard care or a placebo in adults with non-severe COVID-19 up to Apr 25, 2022.The researchers noted that most antiviral trials to date have included hospitalized patients with severe or critical disease rather than those with milder illnesses. "Furthermore, although efficacy data from trials of molnupiravir, nirmatrelvir–ritonavir and remdesivir are promising, no head-to-head trials have compared these drugs," they wrote. "This is particularly important as health care systems attempt to prioritize access to effective COVID-19 treatments in the early stages of the disease."No death reduction with remdesivir Most trials in the meta-analysis involved unvaccinated patients and were conducted before the emergence of the highly transmissible Omicron variant.
Most patients were 36.5 to 65.5 years old, and proportions of men and women were comparable.A total of 32 trials with 10,837 patients reported 291 deaths over a median follow-up of 29 weeks.
The researchers assumed a baseline risk of 13.3 deaths per 1,000 patients based on median risk in the standard-care and placebo groups.Molnupiravir and Paxlovid each lowered the risk of death beyond standard