Molnupiravir vs Remdesivir for Treatment of Covid-19 in Lung Transplant Recipients

Abstract

Purpose

Three SARS-CoV-2-directed anti-viral therapies are currently accessible in the United States: remdesivir (REM), molnupiravir (MOL), and nirmatrelvir+ritonavir. The latter has significant drug-drug interactions and is typically not used in lung transplant recipients (LTRs). We compared the efficacy between early REM and MOL treatment of LTRs with COVID-19.

Methods

LTRs who contracted COVID-19 between 3/2020 and 8/2022 were identified. LTRs with COVID-19 that were well enough to remain outpatient were treated with either REM or MOL, depending on drug availability; REM became available in 10/2020 and MOL in 12/2021. The primary outcome was hospitalization and the secondary outcome was mortality. The analysis was adjusted for SARS-CoV-2 strain, vaccination status, pre-exposure prophylaxis with tixagevimab-cilgavimab, and COVID-19 therapies, eg, monoclonal antibodies and modification of anti-proliferative agent.

Results

Of 195 LTRs that developed COVID-19 during the study period, 54 were included and divided into groups: REM (n=25) or MOL (n=29). The baseline characteristics of the two groups were comparable (Table 1). On unadjusted analysis, LTRs treated with MOL were less likely to be hospitalized, admitted to the ICU, or to die from COVID-19; on adjusted analysis, only reduced likelihood of hospitalization remained statistically significant (p=0.035). One-year survival probability was comparable between the groups, but trended lower among LTRs treated with REM (REM: 64% vs MOL: 93.1%, p=0.081, Figure 1).

Conclusion

LTRs with COVID-19 treated with MOL were less likely to be hospitalized due to COVID-19 than those treated with REM.