Simple Summary The results of previous studies may suggest that Nirmatrelvir/Ritonavir, when evaluated against placebo controls, could potentially be more effective than Molnupiravir in reducing COVID-19 progression. While Nirmatrelvir/Ritonavir reduced COVID-19 progression risk by 88% versus placebo, Molnupiravir reduced it by 31%. However, there has been no direct head-to-head comparison between the two drugs in a prospective randomized trial. This study compared the safety and effectiveness of Nirmatrelvir/Ritonavir versus Molnupiravir in the treatment of mild-to-moderate COVID-19 in 240 immunocompromised cancer patients who received one of the two drugs. The results showed no significant differences in the rate of disease progression between the treatments. Nevertheless, those treated with Nirmatrelvir/Ritonavir reported a higher incidence of drug interactions and adverse events. Therefore, although both medications are effective in preventing severe disease or death in cancer patients with COVID-19, Molnupiravir could be safer than Nirmatrelvir/Ritonavir in terms of drug interactions and adverse effects. Abstract Background: Nirmatrelvir/Ritonavir has been shown to reduce the risk of COVID-19 progression by 88% compared to placebo, while Molnupiravir reduced it by 31%. However, these two agents have not been compared head-to-head. We therefore compared the safety and efficacy of both agents for the treatment of mild-to-moderate COVID-19 in immunocompromised cancer patients. Methods: We identified 240 cancer patients diagnosed with COVID-19 and treated with Molnupiravir or Nirmatrelvir/Ritonavir. Patients were matched using a 1:2 ratio based on age group (18–64 years vs. ≥65) and type of cancer. The collected data included demographics, comorbidities, and treatment outcome. Results: Both groups had comparable characteristics and presenting symptoms. However, dyspnea was more prevalent in the Molnupiravir group, while sore throat was more prevalent in the Nirmatrelvir/Ritonavir group. The rate of disease progression was comparable in both groups by univariate and multivariable analysis. Treatment with Molnupiravir versus Nirmatrelvir/Ritonavir revealed no significant difference in disease progression by multivariable analysis (adjusted OR = 1.31, 95% CI: 0.56–3.14, p = 0.70). Patients who received Nirmatrelvir/Ritonavir, however, were significantly more prone to having drug–drug interactions/adverse events (30% vs. 0%, p < 0.0001). Conclusions: In the treatment of mild-to-moderate COVID-19 in cancer patients, Molnupiravir was comparable to Nirmatrelvir/Ritonavir in preventing progression to severe disease/death and rebound events, and it had a superior safety profile.
【저자키워드】 COVID-19, Treatment, SARS-CoV-2, Coronaviruses, therapy, molnupiravir, Cancer, Immunocompromised, Paxlovid, Nirmatrelvir/ritonavir,