Victoria Kauer, David Totschnig, Max Augustin, Ferdinand Waldenberger, Mario Karoly, Michelle Nägeli, Christoph Wenisch, Alexander Zoufaly
Background: The use of outpatient antiviral treatment for high-risk patients with coronavirus disease 19 (COVID-19) is crucial in preventing the progression to severe COVID-19 and reducing hospitalization rates.
Objective: The main goal of this retrospective, single-center analysis was to assess the feasibility and potential clinical impact of an outpatient administration of various available antiviral agents including Sotrovimab (SOT), Nirmatrelvir/Ritonavir (N/R), and Molnupiravir (MOL) to COVID-19 patients at high risk for disease progression. In addition, hospital admission rates between groups, side effects and subjective treatment effects were assessed.
Methods: We conducted a retrospective analysis on 2606 outpatient individuals with mild to moderate COVID-19 at risk for disease progression, hospitalization, or death. After receiving either SOT (420/2606), MOL (1788/2606), or N/R (398/2606), patients were followed-up regarding primary (hospitalization rate) and secondary (treatment and side effects) outcomes by phone.
Result: A total of 2606 patients were treated at the outpatient clinic, of whom 420 were treated with SOT, 398 with N/R, and 1788 with MOL. 10 patients (3.2%) who were treated with SOT were later hospitalized and 1 patient had to be admitted to the ICU. In comparison, 11 patients (0.8%) who received MOL were admitted to the hospital (2 admissions to the Intensive Care Unit (ICU). No hospital/ICU admission was registered for patients who received N/R. In contrast, 46 patients (14.3%) who received N/R reported strong to severe side effects, exceeding SOT with 2.6% of the patients (8 patients in total) and MOL with 5% (69 patients) reporting strong to severe side effects. A reduction in COVID symptoms after the medication administration was experienced by 43% (132 patients) in the SOT group, 43% (572 patients) in the MOL group, and 67% (115 patients) in the N/R group, respectively. In over 60-year-olds and chronic kidney disease, no subjective symptom improvement is to be expected with MOL. Women have a 1.2 elevated chance of symptom improvement with treatment with MOL.
Conclusion: Hospitalization rates in high-risk patients who received SOT, MOL, or N/R were low, particularly in patients who received N/R. All antiviral drugs were well tolerated, but side effects were more frequent in patients with N/R. However, N/R showed the greatest subjective treatment effect.