Among asthma patients infected with COVID-19, those who received the antiviral drug nirmatrelvir-ritonavir (Paxlovid) had significantly lower risks of all-cause hospitalization than those given molnupiravir (Lagevrio), Chinese University of Hong Kong researchers report.
For the study, published late last week in Respiratory Research, the team retrospectively analyzed real-world data on 1,745 adult asthma patients hospitalized for COVID-19 from March 2022 to October 2023, with a median follow-up of 1 year. The team compared outcomes among 621 patients who received Paxlovid, 378 molnupiravir recipients, and 746 controls who received neither antiviral.
Acute outcomes were considered those occurring in the first 30 days after symptom onset, and post-acute outcomes were those reported from days 31 to 365.
Choice of antiviral based on patient risk factors, timing
Both Paxlovid and molnupiravir can be used in nonhospitalized patients at high risk for severe COVID-19. The decision to prescribe one antiviral over another for COVID-19 depends primarily on patient risk factors and timing, with Paxlovid preferred for high-risk patients within 5 days of symptom onset, and molnupiravir used when Paxlovid can't be considered (eg, in patients taking certain drugs or those with severe kidney or liver impairment).
"According to the existing evidence, asthma is unlikely to be associated with an increased risk of severe COVID-19 in general," the investigators wrote. "Nevertheless, severe asthma was found to be a risk factor of COVID-19 related death during the early phase of pandemic."
They described this study as the first designed specifically for patients with asthma and studied with a sufficiently long follow-up for post-COVID outcomes.
Paxlovid also benefitted patients with mild asthma
Paxlovid recipients were at significantly lower risk for acute in-hospital death (hazard ratio [HR], 0.27), post-acute in-hospital death (HR, 0.49), all-cause hospitalization (HR, 0.72), and heart attack (HR, 0.10) than control patients.
The post-acute benefits of the antivirals were also demonstrated in patients with mild asthma, which have not been generally recommended in existing clinical management guidelines.
The risk of all-cause hospitalization was significantly lower among Paxlovid recipients than in the molnupiravir group (HR, 0.65). Among patients taking medium- or high-dose inhaled corticosteroids (ICs), the Paxlovid group was at lower risk for asthma exacerbation than molnupiravir recipients (HR, 0.58).
A subgroup analysis showed that both antivirals were more effective in reducing the risk of post-acute death and hospitalization in patients with mild asthma (ie, those prescribed no or low-dose ICs) than among those with moderate or severe asthma (ie, those prescribed medium- or high-dose ICs).
"Compared with molnupiravir, nirmatrelvir/ritonavir may offer more benefits in reducing the risk of post-acute sequelae of COVID-19 among asthma patients," the study authors wrote. "In addition, the post-acute benefits of the antivirals were also demonstrated in patients with mild asthma, which have not been generally recommended in existing clinical management guidelines."
