Clinical effectiveness of molnupiravir in patients with COVID-19 undergoing haemodialysis

Abstract

Molnupiravir is an essential oral antiviral agent against coronavirus disease 2019 (COVID-19); however, its real-world effectiveness has not been evaluated in patients undergoing hemodialysis (HD). We conducted a multicenter retrospective study involving 225 patients undergoing HD with initially mild or asymptomatic COVID-19 to compare the risks of 30-day COVID-19-related acute care visits between patients receiving and not receiving molnupiravir. Additionally, patients who received molnupiravir were stratified by rapid antigen detection (RAD) test results on day 7 after disease onset to assess whether rapid molnupiravir introduction accelerated viral clearance. In our analysis, 30-day COVID-19-related acute care visits were reported in 9.41% and 21.74% of the molnupiravir and control groups, respectively, and use of molnupiravir markedly reduced the risk of acute care visits after adjusting for baseline characteristics via propensity score weighting (hazard ratio (95% confidence interval (CI)), 0.218 (0.074-0.642); p = 0.006). The tolerability of molnupiravir in the enrolled patients was generally acceptable, with only 11.88% of molnupiravir users reporting mild adverse events. Moreover, rapid initiation of molnupiravir within one day of COVID-19 onset was an independent predictor of conversion to a negative RAD test result on day 7 after disease onset (odds ratio (95% CI), 6.207 (2.509-15.358); p < 0.001). Molnupiravir is well tolerated and decreases the medical needs in COVID-19 patients undergoing HD. Furthermore, the rapid initiation of molnupiravir accelerates viral clearance in HD patients with COVID-19. Our findings highlight the therapeutic role of molnupiravir for this vulnerable population.