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.
背景：与安慰剂相比，奈玛特韦/利托那韦可将COVID-19进展风险降低88%，而莫诺拉韦可降低31%。然而，这两种药物尚未进行头对头比较。因此，我们比较了这两种药物治疗免疫功能低下癌症患者轻中度COVID-19的安全性和有效性。方法：我们确定了240名诊断为COVID-19并接受莫诺拉韦或奈玛特韦/利托那韦治疗的癌症患者。根据年龄组（18-64岁 vs. ≥65岁）和癌症类型，以1:2的比例对患者进行匹配。收集的数据包括人口统计学特征、合并症和治疗结果。结果：两组患者特征和临床表现症状具有可比性。然而，莫诺拉韦组呼吸困难更为普遍，而奈玛特韦/利托那韦组咽痛更为普遍。通过单变量和多变量分析，两组的疾病进展率相当。多变量分析显示，莫诺拉韦与奈玛特韦/利托那韦治疗在疾病进展方面无显著差异（调整后OR = 1.31，95% CI：0.56–3.14，p=0.70）。然而，接受奈玛特韦/利托那韦治疗的患者发生药物相互作用/不良事件的风险显著更高（30% vs. 0%，p<0.0001）。结论：在癌症患者轻中度COVID-19的治疗中，莫诺拉韦在预防疾病进展为重症/死亡及反弹事件方面与奈玛特韦/利托那韦相当，且具有更优的安全性。
肿瘤(癌症)患者之家