Real-World Utilization of Molnupiravir during the COVID-19 Omicron Surge in Israel

• Published in: Epidemiolgia (Basel, Switzerland) Vol. 4; no. 3; pp. 309 - 321
• Main Authors: Weil, Clara, Bergroth, Tobias, Eisenberg, Anna, Whiteside, Yohance Omar, Caraco, Yoseph, Tene, Lilac, Chodick, Gabriel
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 10.08.2023; MDPI
• Subjects: Antiviral drugs; COVID-19; COVID-19 vaccines; Drug dosages; Epidemiology; molnupiravir; Mortality; SARS-CoV-2; Socioeconomic factors; Israel
• ISSN: 2673-3986; 2673-3986
• DOI: 10.3390/epidemiologia4030031

Molnupiravir (MOV) was introduced in Israel in January 2022 during the SARS-CoV-2 Omicron surge for high-risk patients contraindicated for nirmatrelvir/ritonavir. This retrospective cohort study aimed to describe characteristics of patients offered COVID-19 antiviral treatment in Maccabi Healthcare Services (antiviral treatment-eligible cohort; n = 5596) between 12 January and 28 February 2022, and the subset of these who were dispensed MOV (MOV-treated cohort; n = 1147), as well as outcomes following MOV dispensation. Median (interquartile range) age in the antiviral treatment-eligible and MOV-treated cohorts were 70.5 (61.1, 77.3) and 74.1 (64.3, 81.7) years, respectively. The MOV-treated cohort (male: 53.2%) had high rates of COVID-19 vaccination (91.4%) and comorbidities, including immunosuppression (40.0%) and chronic kidney disease (67.0%; eGFR < 30 mL/min/1.73 m2: 28.8%), and most used comedications either contraindicated or with major potential for drug–drug interactions with nirmatrelvir/ritonavir (87.3%). At 28 days post-MOV dispensation, the cumulative incidence (95% CI) of COVID-19-related hospitalization and/or all-cause mortality was 3.6% (2.5%, 4.6%), with similar rates across sexes and age groups (18–64 vs. ≥65 years), and lower rates among recently vaccinated and/or recently SARS-CoV-2-infected patients. These data describe the characteristics and outcomes for MOV-treated patients in Israel, whose clinical characteristics may preclude the use of nirmatrelvir/ritonavir to treat their COVID-19 infection.