Evidence map›Paper›PMID 41382264›Full record

ArticleBMC infectious diseases2025

Effectiveness comparison of nirmatrelvir/ritonavir versus molnupiravir in COVID-19 patients with comorbidities in Taiwan: a multi-centre electronic health record study.

Wen-Kuang Lin, Shwu-Jiuan Lin, Yu-Hui Chang, Fu-Der Wang, Phung-Anh Nguyen, Phan Thanh Phuc, Whitney Burton, Nguyen Thi Kim Hien, Chia-Chieh Lin, Carlos Shu-Kei Lam and 8 more

Abstract readComparative StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Wen-Kuang LinSchool of Pharmacy, College of Pharmacy, Taipei Medical University, No.250, Wuxing St., Xinyi Dist., Taipei City, 110, Taiwan (R.O.C.).
Shwu-Jiuan LinSchool of Pharmacy, College of Pharmacy, Taipei Medical University, No.250, Wuxing St., Xinyi Dist., Taipei City, 110, Taiwan (R.O.C.).
Yu-Hui ChangSchool of Pharmacy, College of Pharmacy, Taipei Medical University, No.250, Wuxing St., Xinyi Dist., Taipei City, 110, Taiwan (R.O.C.).
Fu-Der WangDivision of Infection Diseases, Department of Internal Medicine, Taipei Medical University Hospital, No. 252, Wuxing St, Xinyi District, Taipei City, 110, Taiwan (R.O.C.).
Phung-Anh NguyenClinical Data Center, Office of Data Science, Taipei Medical University, No.250, Wuxing St., Xinyi Dist., Taipei City, 110, Taiwan (R.O.C.).
Phan Thanh PhucInternational Ph.D. Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, 11 Fl., Biomedical Technology Building, 301 Yuantong Rd., Zhonghe Dist., New Taipei City, 235, Taiwan (R.O.C.).
Whitney BurtonInternational Ph.D. Program in Biotech and Healthcare Management, College of Management, Taipei Medical University, 11 Fl., Biomedical Technology Building, 301 Yuantong Rd., Zhonghe Dist., New Taipei City, 235, Taiwan (R.O.C.).
Nguyen Thi Kim HienMaster Program in Global Health and Health Security, College of Public Health, Taipei Medical University, No.250, Wuxing St., Xinyi Dist., Taipei City, 110, Taiwan (R.O.C.).
Chia-Chieh LinDepartment of Pharmacy, Taipei Veterans General Hospital, No.201, Sec. 2, Shipai Rd., Beitou District, Taipei City, 112, Taiwan (R.O.C.).
Carlos Shu-Kei LamEmergency Department, Department of Emergency and Critical Care Medicine, Wan Fang Hospital, Taipei Medical University, No.111, Sec. 3, Xinglong Rd., Wenshan Dist., Taipei City, 116, Taiwan (R.O.C.).
To-Chi HaDepartment of Emergency and Critical Care Medicine, Taipei Medical University Shuang Ho Hospital, No.291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan (R.O.C.).
Christine Y LuDepartment of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Dr, Boston, MA, 02215, USA.
Chih-Wei HuangClinical Big Data Research Center, Taipei Medical University Hospital, Taipei Medical University, No. 252, Wuxing St, Xinyi District, Taipei City, 110, Taiwan (R.O.C.).
Hsuan-Chia YangClinical Big Data Research Center, Taipei Medical University Hospital, Taipei Medical University, No. 252, Wuxing St, Xinyi District, Taipei City, 110, Taiwan (R.O.C.).
Shiue-Ming LinResearch Center of Data Science on Healthcare Industry, College of Management, Taipei Medical University, 11 Fl., Biomedical Technology Building, 301 Yuantong Rd., Zhonghe Dist., New Taipei City, 235, Taiwan (R.O.C.).
Chieh YangResearch Center of Data Science on Healthcare Industry, College of Management, Taipei Medical University, 11 Fl., Biomedical Technology Building, 301 Yuantong Rd., Zhonghe Dist., New Taipei City, 235, Taiwan (R.O.C.).
Li-Hsuan WangSchool of Pharmacy, College of Pharmacy, Taipei Medical University, No.250, Wuxing St., Xinyi Dist., Taipei City, 110, Taiwan (R.O.C.).
Jason C HsuClinical Data Center, Office of Data Science, Taipei Medical University, No.250, Wuxing St., Xinyi Dist., Taipei City, 110, Taiwan (R.O.C.). jasonhsu@tmu.edu.tw.

Funding

National Science and Technology Council NSTC 112-2314-B-038-083Taiwan Centers for Disease Control MOHW114-CDC-C114-000115
6 · The paper itself

Abstract

backgroundCOVID-19 patients frequently present with various comorbidities. Two developed antiviral medications, nirmatrelvir/ritonavir and molnupiravir, have been utilized in COVID-19 patients; but comparisons of the effectiveness between nirmatrelvir/ritonavir and molnupiravir in COVID-19 patients with different comorbidities remain unknown. This study aims to compare the effectiveness, including invasive ventilation and mortality, of nirmatrelvir/ritonavir and molnupiravir in the overall population and populations with various comorbidities in Taiwanese patients during the omicron BA.2 wave.

methodsWe retrospectively collected electronic medical records from the Taipei Medical University Clinical Research Database between January and December 2022 and conducted an analysis of adult patients diagnosed with SARS-CoV-2 infection. For data management, we performed propensity score matching to minimize the imbalance between two groups; the standardized mean difference > 0.1 or a p value < 0.05 considered statistically significant. Variables, which remained imbalanced after matching, were adjusted by cox regression model. To identify the risk associated with these variables, a Cox proportional hazards model were performed. Kaplan-Meier method was applied to estimate invasive ventilation and mortality, comparing survival curves between nirmatrelvir/ritonavir users and molnupiravir users.

resultsOur cohort was recruited from a database, including patients who receive nirmatrelvir/ritonavir or molnupiravir treatment. Out of a total of 35,617 patients, 968 patients received nirmatrelvir/ritonavir and 1198 patients received molnupiravir after matching. Patients with chronic liver disease or mental disease on nirmatrelvir/ritonavir had lower risks of intubation than those on molnupiravir. Overall, nirmatrelvir/ritonavir reduced mortality risk by 65% (adjusted hazard ratio (aHR): 0.35, 95% confidence interval (CI): 0.14-0.88, p = 0.026). For patients with diabetes mellitus (aHR: 0.29, 95% CI: 0.11-0.78, p = 0.014), with chronic kidney disease (aHR: 0.26, 95% CI: 0.10-0.68, p = 0.007), or aged over 65 years (aHR: 0.30, 95% CI: 0.13-0.70, p = 0.005), nirmatrelvir/ritonavir demonstrated superior efficacy in reducing mortality risk compared to molnupiravir.

conclusionsData revealed that both nirmatrelvir/ritonavir and molnupiravir demonstrated clinical benefits in treating COVID-19 patients in a real-world setting. Moreover, nirmatrelvir/ritonavir was associated with a lower risk of mortality in COVID-19 patients with specific circumstances. CLINICAL TRIAL: Clinical trial number is not applicable.

Indexed as

Antiviral AgentsCOVID-19COVID-19 Drug TreatmentCytidineHydroxylaminesMorpholinesProlineRitonavirAdultAgedComorbidityElectronic Health RecordsFemaleHumansIminesMaleAntiviral AgentsCytidineHydroxylaminesIminesmolnupiravirMorpholinesProlineRitonavirComorbidityCOVID-19MolnupiravirNirmatrelvir/ritonavirTaipei medical university clinical research database (TMUCRD)Taiwan

Identifiers

PMID41382264
PMCPMC12801939

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.