Trial reportAnnals of internal medicine2023
Effectiveness of Molnupiravir and Nirmatrelvir-Ritonavir in Hospitalized Patients With COVID-19 : A Target Trial Emulation Study.
Trial report in Annals of internal medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
33 citing papers in PubMed, 1 synthesis or guideline pooled it, 50 citations in OpenAlex.
- Nirmatrelvir combined with ritonavir for preventing and treating COVID-19.The Cochrane database of systematic reviews · 2023Pooled it
- Real Clinical Effectiveness of Molnupiravir Against 30-day Mortality Among 74 541 SARS-CoV-2-Positive Patients: A Nationwide Cohort Study From the Czech Republic.Open forum infectious diseases · 2024Trial
- Effectiveness of the Approved Nirmatrelvir/Ritonavir and Molnupiravir Regimens for Treatment of Mild/Moderate Laboratory-Confirmed SARS-CoV-2 Infection in Patients Aged 18-64 Years in Hong Kong: A Population-Based Cohort Study.Clinical drug investigation · 2026Article
- Corticosteroids with or without antiviral therapy in elderly patients hospitalized with COVID-19 during the Omicron era: A multicenter real-world study.Journal of virus eradication · 2026Article
- Effectiveness of nirmatrelvir/ritonavir and molnupiravir on post-COVID diabetes risk among an older adult cohort: a target trial emulation study.BMC medicine · 2026Article
- Design and Implementation of Observational Studies Emulating a Target Trial.JAMA network open · 2026Article
- Development and validation of age-specific predictive models on the risk of post-acute mortality within 1 year of COVID-19 infection.QJM : monthly journal of the Association of Physicians · 2026Article
- Safety and Efficacy of Concomitant Nirmatrelvir/Ritonavir and Direct Oral Anticoagulant Therapies for COVID-19 Among Patients With Atrial Fibrillation.Journal of the American Heart Association · 2026Article
- Effectiveness of nirmatrelvir/ritonavir and molnupiravir in reducing the risk of short-term and long-term cardiovascular complications of COVID-19: a target trial emulation study.Nature communications · 2025Article
- Greater benefits of immediate nirmatrelvir-ritonavir initiation for post-COVID outcomes: a population-based retrospective cohort study.Nature communications · 2025Article
- Real-world effectiveness of simnotrelvir-ritonavir versus nirmatrelvir-ritonavir in hospitalized patients with COVID-19 during the omicron wave in China: a retrospective cohort study.BMC infectious diseases · 2025Article
- Short- and long-term comparative effectiveness of nirmatrelvir/ritonavir and molnupiravir in asthma patients: a cohort study.Respiratory research · 2025Article
- The Effect of Nirmatrelvir-Ritonavir on Short- and Long-term Adverse Outcomes From COVID-19 Among Patients With Kidney Disease: A Propensity Score-Matched Study.Open forum infectious diseases · 2025Article
- Post-acute sequelae of hospitalised COVID-19 re-infection compared with hospitalised first-time infection: a population-based retrospective cohort study in Hong Kong.BMJ public health · 2025Article
- Factors associated with seeking and receiving home antiviral therapy during the coronavirus disease 2019 (COVID-19) pandemic.Discover public health · 2025Article
- COVID-19 vaccination modified the effect of nirmatrelvir-ritonavir on post-acute mortality and rehospitalization: a retrospective cohort study.Emerging microbes & infections · 2024Article
- Myasthenia gravis following statin therapy: evidence from target trial emulation and self-controlled case series study.Nature communications · 2024Article
- Nationwide Target Trial Emulation Evaluating the Clinical Effectiveness of Oral Antivirals for COVID-19 in Korea.Journal of Korean medical science · 2024Article
- Target Trial Emulation for Evaluating Health Policy.Annals of internal medicine · 2024Article
- Morbidity and Mortality of Hospital-Onset SARS-CoV-2 Infections Due to Omicron Versus Prior Variants : A Propensity-Matched Analysis.Annals of internal medicine · 2024Article
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Authors and funding
16 authors at 6 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundWhether hospitalized patients benefit from COVID-19 oral antivirals is uncertain.
objectiveTo examine the real-world effectiveness of molnupiravir and nirmatrelvir-ritonavir in hospitalized patients with COVID-19 during the Omicron outbreak.
designTarget trial emulation study.
settingElectronic health databases in Hong Kong.
participantsThe molnupiravir emulated trial included hospitalized patients with COVID-19 aged 18 years or older between 26 February and 18 July 2022 (
interventionInitiation of molnupiravir or nirmatrelvir-ritonavir within 5 days of hospitalization with COVID-19 versus no initiation of molnupiravir or nirmatrelvir-ritonavir. MEASUREMENTS: Effectiveness against all-cause mortality, intensive care unit (ICU) admission, or use of ventilatory support within 28 days.
resultsThe use of oral antivirals in hospitalized patients with COVID-19 was associated with a lower risk for all-cause mortality (molnupiravir: hazard ratio [HR], 0.87 [95% CI, 0.81 to 0.93]; nirmatrelvir-ritonavir: HR, 0.77 [CI, 0.66 to 0.90]) but no significant risk reduction in terms of ICU admission (molnupiravir: HR, 1.02 [CI, 0.76 to 1.36]; nirmatrelvir-ritonavir: HR, 1.08 [CI, 0.58 to 2.02]) or the need for ventilatory support (molnupiravir: HR, 1.07 [CI, 0.89 to 1.30]; nirmatrelvir-ritonavir: HR, 1.03 [CI, 0.70 to 1.52]). There was no significant interaction between drug treatment and the number of COVID-19 vaccine doses received, thereby supporting the effectiveness of oral antivirals regardless of vaccination status. No significant interaction between nirmatrelvir-ritonavir treatment and age, sex, or Charlson Comorbidity Index was observed, whereas molnupiravir tended to be more effective in older people. LIMITATION: The outcome of ICU admission or need for ventilatory support may not capture all severe COVID-19 cases; unmeasured confounders, such as obesity and health behaviors, may exist.
conclusionMolnupiravir and nirmatrelvir-ritonavir reduced all-cause mortality in both vaccinated and unvaccinated hospitalized patients. No significant reduction in ICU admission or the need for ventilatory support was observed. PRIMARY FUNDING SOURCE: Health and Medical Research Fund Research on COVID-19, Government of the Hong Kong Special Administrative Region; Research Grants Council, Collaborative Research Fund; and Health Bureau, Government of the Hong Kong Special Administrative Region.
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