Abstract
Background: Molnupiravir is a type of medication used to treat coronavirus disease 2019 (COVID-19). However, no evidence regarding the therapeutic effect of molnupiravir combined with clarithromycin (CAM) on blood biomarkers is available. Methods: Of the 156 rehabilitation patients, 124 patients with mild-to-moderate COVID-19 were treated with molnupiravir. Among these 124 patients, 54 were treated with CAM. The remaining 28 rehabilitation patients were negative for COVID-19. Blood biomarkers were assessed after administration of molnupiravir in patients receiving molnupiravir plus CAM or molnupiravir alone. Results: Among the measured blood biomarkers, lactate dehydrogenase, potassium, white blood cells, C-reacted protein, neutron–lymphocyte ratio, fibrin degradation product, and prothrombin time–international normalized ratio values were significantly higher (P < 0.05) in the molnupiravir alone group than in the molnupiravir plus CAM group, and lymphocytes were significantly lower (P < 0.05) on day 5 after admission. In the molnupiravir plus CAM group, immunoglobulin (Ig) A levels increased and soluble interleukin 2-receptor levels (sIL2R) decreased (P < 0.05) on day 14 after admission. In addition, COVID-19-negative patients had higher IgA levels and lower sIL2R levels compared to infected patients (P < 0.05). The concomitant administration of molnupiravir plus CAM resulted in fewer sequelae after 12 months, and the incidence of venous thromboembolism was significantly reduced (P < 0.05). Conclusion: In patients with mild-to-moderate COVID-19, concomitant administration of molnupiravir plus CAM showed several non-worsening blood biomarkers, elevated immune activity, and reduced post-infection sequelae. Relevance for Patients: After administration of molnupiravir to patients with mild-to-moderate COVID-19, administration of CAM to patients suffering from secondary macrolide-sensitive bacterial infection was compared with administration of molnupiravir alone. D-dimer, IgA, and sIL2R are potential predictive factors of disease severity in critically ill patients with COVID-19.
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