Real-world experience with antivirus for the treatment of COVID-19

Abstract

Background: The use of oral antivirals plays an important role in controlling the severity and spread of the novel coronavirus 2019.

Objective: To evaluate the treatment effect and safety of oral antivirals used at Hua Hin Hospital.

Method: A retrospective study was conducted from the medical records of COVID-19 patients receiving oral antiviral therapy. Between April and July 2022, when molnupiravir was introduced and used for the first time in Thailand.

Results: Out of 1,014 patients with COVID-19 aged 18 and over who were not pregnant and planned to receive antiviral therapy for COVID-19, 58 received molnupiravir; 27 were outpatients and 31 were inpatients. Patients treated with favipiravir were matched based on age, gender, vaccination history, and the risk factors for severe symptoms from COVID-19 according to patients taking molnupiravir. The treatment outcomes and adverse reactions from oral antivirals were evaluated using the chi-square test and independent t-test. We found that 3.7% of the molnupiravir and 7.4% of the favipiravir outpatient groups (p =.492) were admitted to the hospital one day after home isolation treatment. The mean length of hospital stay was not different between the molnupiravir and favipiravir groups (6.35 days (SD 3.52) and 7.96 days (SD 3.96), respectively) (p = 0.78). No patient was found dead. This was not different from favipiravir patients who were 3.2% admitted to intensive care units, 6.5% received corticosteroids, and 6.5% died. Favipiravir was converted to remdesivir by 19.4%, whereas the molnupiravir group had no conversion to remdesivir (p =.024). Two mild adverse events were reported in the molnupiravir group, and no patients recurred in 28 days.

Conclusion: The use of favipiravir and molnupiravir as oral anti-coronavirus drugs for outpatients can treat COVID-19 without difference. While the use of favipiravir in hospitalized patients requiring conversion to remdesivir was higher than in the molnupiravir group, and two deaths were reported. There were no serious adverse events or recurrences at 28 days found in either patient group.