The Lancet: New crown oral drug significantly reduces infection mortality in the elderly

On October 8, The Lancet published an article “Real-world effectiveness of molnupiravir and nirmatrelvir plus ritonavir against mortality, hospitalisation, and in-hospital outcomes among community-dwelling, ambulatory patients with confirmed SARS-CoV-2 infection during the omicron wave in Hong Kong: an observational study”, this is a real-world study on the effectiveness of two new crown oral drugs in the treatment of Omicron variant strain infection. biggest.

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The research data comes from 1,074,856 community-infected patients in Hong Kong in 2022. After screening, 4,983 molnupiravir users and 5,542 Paxlovid users were included in the statistics, of which 9,176 were older than 60 aged (87.1%), and only 2,650 (22.4%) had completed the full course of vaccination.

That is, most of them are at high risk for Covid-19 infection—older and under-vaccinated.

The study found that the use of two new crown drugs in the early stage of infection can significantly reduce the risk of disease progression and death in the elderly. Among them, the new crown oral drug Paxlovid reduced the risk of death after hospitalization in the elderly 79%.

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Coronavirus Oral Drugs

Significant reduction in risk of disease progression and death

In this study, researchers from the Faculty of Medicine of the University of Hong Kong set up different control groups for the two drugs at a ratio of about 1:10—the new crown was not used orally after infection. special medicine.

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During an average follow-up period of about 100 days: the all-cause mortality (including other diseases or natural death, etc.) in the molnupiravir treatment group was 17.9/100,000 person-days, which was lower than that in the control group 24%;

Paxlovid treatment group was 4.2/100,000 person-days, a 66% reduction compared to the control group.

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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.

After admission, the molnupiravir group 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.

Paxlovid also significantly reduced the risk of disease progression (43%) and the risk of death (75%) after admission.

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The study found that within 28 days of infection: Hospitalization, discharge, and in-hospital mortality rates were approximately 9%, 6.4%, and 0.9% in the molnupiravir-treated group, compared with 8.9% in the control group. %, 5.5% and 1.5%;

Inpatient, discharge, and in-hospital mortality rates were approximately 3.9%, 3.1%, and 0.2% in the Paxlovid-treated group, compared with 5%, 3.3%, and 0.7%, respectively, in the control group.

Disease status in treatment and control groups over 28 days.

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Single drug use

Long-term or induced resistance to SARS-CoV-2

According to the relevant guidelines issued by the Department of Health of the Hong Kong SAR Government, the use of molnupiravir and Paxlovid is preferred for people with mild initial infection symptoms but high risk factors for disease progression, including advanced age, unvaccinated or Combined with chronic diseases, etc.

According to the data released by the Centre for Health Protection of the Department of Health of the Hong Kong Special Administrative Region Government, during the peak period of the fifth wave of the epidemic in Hong Kong (December 31, 2021 to April 7, 2022), the cumulative number of deaths after infection Among the 8,344 people in China, 96% are over 60 years old, while the mortality rate of infected people under 60 years old is only about 0.04%.

In addition to the use of oral Covid-19 drugs, vaccinations are also helping to turn things around. In this study, although molnupiravir did not reduce the risk of hospitalization in infected people, it reduced the risk of hospitalization by 34% when analyzed only in the subgroup that completed the vaccination.

Previously, on March 22, the research team of the University of Hong Kong released a study through the medrxiv preprint platform, saying that the effectiveness of the two new crown vaccines, Fubitai and Kexing, has been confirmed by the latest and powerful real-world data. data support.

The study used data on individual cases of mild/severe critical illness/death from Omikoron infection between December 31, 2021 and March 8, 2022, and concluded that Under the widespread dissemination of Omicron substrain BA.2, inoculation of 3 doses of inactivated (Kexinger Life) or mRNA (Fosun Fubitai) new crown vaccine can effectively prevent severe illness or death regardless of age. The protection power is more than 97%.

Efficacy of three injections:

Prevention of mild/common symptoms:

[20-60 year olds] Fubitai: 71.5%; Kexing: 42.3%;

[People over 60 years old] Fubitai: 71.6%; Kexing: 50.7%;

Severe/Critical Prevention:

【20-60 year olds】Forbidden: 98.5%; Kexing: 98.5%;

[People over 60 years old] Fubitai: 98.0%; Kexing: 97.9%;

Death Prevention:

[20-60 year olds] Fubitai: 99.4%; Kexing: –

【People over 60 years old】 Forbidden: 98.1%; Kexing: 98.3%

It can be seen that the use of vaccines combined with specific drugs is to further reduce the mysteriousEffective ways of health risks after Chrono infection.

And post-infection, the study says, governments and health care should give due consideration to the distribution of oral antiviral drugs, allowing infected people to use them as soon as symptoms appear for maximum benefit.

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.


1.Ling Jun: “The Lancet” launched a real-world study in Hong Kong: New crown oral drug significantly reduces infection mortality in the elderly. Medical profession. 2022-10-09

2. “Hong Kong’s real-world data “slap in the face”: preventing severe illness and death, the difference between the two vaccines is really not as big as imagined! “. The Lancet at Sea. 2022-03-23

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Sources|The Lancet Journal, Medical Profession, The Lancet at Sea, Centre for Health Protection, Department of Health, HKSAR Government