“Government and health care should give due consideration to the distribution of oral medications for COVID-19.”
Writing |Ling Jun
Source | “Medical Community” Public Account
On October 8th, the top issue of The Lancet published the largest real-world study to date on the effectiveness of two new crown oral drugs in the treatment of Omikoron infection.
The data comes from the Omicron epidemic in Hong Kong this year. Among the more than 1 million community infected people, 11,847 people used the new crown oral drug molnupiravir or Paxlovid in community outpatient clinics. Most of them have Be in a high-risk group for Covid-19 – over 60 years old and not vaccinated.
The results showed that early use of two new crown drugs significantly reduced the risk of disease progression and death in the elderly, of which Paxlovid reduced the risk of death after hospitalization by 79%.
Significant reduction in risk of disease progression and death
In this study, scholars from the Faculty of Medicine of the University of Hong Kong analyzed the electronic health records of 1,074,856 patients with COVID-19 between February 26 and June 26, 2022.
After screening, a total of 4,983 molnupiravir users and 5,542 Paxlovid users were included in the statistics, of which 9,176 were over 60 years old (87.1%), and only 2,650 completed the full course of vaccination. people (22.4%).
After matching for age, sex, vaccination status, and underlying medical conditions, the researchers set up a different control group for the two drugs at a ratio of about 1:10 – infection After no specific drugs were used, the first analysis was the all-cause mortality of infected persons (including other diseases or natural deaths, etc.).
Over an average follow-up period of approximately 100 days:
The all-cause mortality rate was 17.9 per 100,000 person-days in the molnupiravir-treated group, a 24% reduction compared to the control group, and 4.2 per 100,000 person-days in the Paxlovid-treated group. 66% lower than the control group.
There was no significant difference between the molnupiravir group and the control group in the risk of hospitalization after infection, with approximately 9% of molnupiravir users requiring hospitalization within 28 days of infection. But after admission, molnupiravir reduced the risk of disease progression by 43% and the risk of in-hospital death by 47%.
The Paxlovid group had a hospitalization rate of only about 3.9%, a risk reduction of about 24% compared to the control group. After admission, Paxlovid also significantly reduced the risk of disease progression (43%) and the risk of death (75%).
Overall, within 28 days of infection:
The hospitalization, discharge, and in-hospital mortality rates were approximately 9%, 6.4%, and 0.9% in the molnupiravir-treated group and 8.9%, 5.5%, and 1.5% in the control group, respectively.
Inpatient, discharge, and in-hospital mortality rates were approximately 3.9%, 3.1%, and 0.2% in the Paxlovid-treated group and 5%, 3.3%, and 0.7% in the control group, respectively
Disease status in treatment and control groups within 28 days
Vaccine combined with oral drug
As early as August 24th, a study published by Israel’s Clalit Medical Group in the New England Journal of Medicine showed that for people over 65 years old, Paxlovid infected Omicron after The risk of hospital admission and death decreased by 73% and 79%, respectively.
Considering that most of the “users” in the two studies were “high-risk groups”, the early use of the two new crown oral drugs can significantly improve the health risk of Omicron infection .
It is worth mentioning that in the control group of this study, there are still more than 90,000 people over the age of 60 who are not taking medication. According to the new crown clinical management guidelines in Hong Kong, molnupiravir and Paxlovid are preferentially used for people with mild initial infection symptoms but high risk factors for disease progression, including advanced age, unvaccinated or combined chronic diseases.
Recalling the peak period of the fifth wave of the epidemic in Hong Kong, from December 31, 2021 to April 7, 2022, among the 8,344 people who died after infection, 96% were over 60 years old, while those under 60 years old accounted for 96%. The mortality rate for infected people is only about 0.04%. Jin Dongyan, a professor at the School of Biomedical Sciences of the University of Hong Kong, told the “medical community” that the initial use of specific drugs was vague and too strict, and some elderly people in the later stage were neither vaccinated nor unwilling to take medicines, which were the main reasons for the high mortality rate of the epidemic in Hong Kong at the beginning of the year.
So, in addition to the use of oral Covid-19 drugs, vaccination can help turn things around. In this study, although molnupiravir did not reduce the risk of hospitalization in infected individuals, it did reduce the risk of hospitalization by 34% when analyzed only in the subgroup that completed the vaccination.
The benefits of vaccination are highlighted in a new study published October 7 in The Lancet Respiratory Medicine, which found that three doses of the mRNA vaccine reduced the risk of hospitalization by up to 80%, Even after vaccination for more than 3 months, the effectiveness in preventing hospitalization for BA.1 and BA.2 infections was 76% and 70%.
Overall, the above studies demonstrate that the use of vaccines in combination with specific medicines is an effective way to further reduce the health risks of Omicron infection. In terms of vaccines, the development and availability of targeted bivalent/multivalent vaccines is still the focus.
And after infection, the University of Hong Kong scholars believe that the government and health care departments should fully consider the supply and distribution of oral antiviral drugs, so that infected people can use them as soon as possible after symptoms appear to obtain maximum efficacy . But they also pointed out in the study that the use of a single drug may induce long-term resistance to the new coronavirus. Therefore, further studies are needed to explore the balance between efficacy and viral resistance of combination therapy.
Source: Medicine
Proofreading: Zang Hengjia
Editor in charge: Tian Dongliang
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