• Klíčová slova
• molnupiravir,
• MeSH
• antivirové látky * farmakologie   terapeutické užití   MeSH
• cytidin analogy a deriváty   farmakologie   terapeutické užití   MeSH
• farmakoterapie COVID-19 * MeSH
• hydroxylaminy farmakologie   terapeutické užití   MeSH
• klinická studie jako téma MeSH
• lidé MeSH
• podvod MeSH
• Check Tag
• lidé MeSH

• Klíčová slova
• molnupiravir,
• MeSH
• antivirové látky farmakologie   terapeutické užití   MeSH
• COVID-19 terapie   MeSH
• cytidin analogy a deriváty   farmakologie   terapeutické užití   MeSH
• farmakoterapie COVID-19 * MeSH
• hydroxylaminy farmakologie   terapeutické užití   MeSH
• lidé MeSH
• randomizované kontrolované studie jako téma MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• zprávy MeSH

Background/Objectives: Molnupiravir (MOV), an oral antiviral COVID-19 treatment, was introduced in the Czech Republic in December 2021 for COVID-19 patients at a high risk of progression to severe disease requiring hospitalization. In this observational, retrospective study, we aimed to describe the characteristics and healthcare resource utilization in non-hospitalized, adult COVID-19 patients prescribed MOV in the Czech Republic between 1 January and 30 April 2022. Methods: A total of 621 patients were included and followed up with for 28 days. Results: The median age was 68.0 (20-99) years, 77.8% were overweight or obese, 14.1% smoked, and 85.7% were vaccinated. The overall cumulative incidence (95% CI) of all-cause hospitalization was 0.71 (0.37; 1.24) per 1000 person years or 1.9%, with similar rates across sexes, age groups, BMI category, multimorbidity category, polypharmacy category, and COVID-19 vaccination status. Among patients reported hospitalized, oxygen-based resources were not observed, and no deaths occurred. Conclusions: These data describe the characteristics and healthcare resource utilization in Czech MOV-treated patients whose clinical characteristics may put them at increased risk of severe disease.

• Publikační typ
• časopisecké články MeSH

• Publikační typ
• novinové články MeSH
• zprávy MeSH

INTRODUCTION: Molnupiravir and nirmatrelvir/ritonavir are antivirals used to prevent progression to severe SARS-CoV-2 infections and decrease hospitalisation and mortality rates. Nirmatrelvir/ritonavir was authorised in Europe in December 2021, whereas molnupiravir is not yet licensed in Europe as of February 2022. Molnupiravir may be an alternative to nirmatrelvir/ritonavir because it is associated with fewer drug-drug interactions and contraindications. A caveat for molnupiravir is the mode of action induces viral mutations. Mortality rate reduction with molnupiravir was less pronounced than that with nirmatrelvir/ritonavir in patients without haematological malignancy. Little is known about the comparative efficacy of the two drugs in patients with haematological malignancy at high-risk of severe COVID-19. Thus, molnupiravir and nirmatrelvir/ritonavir were compared in a cohort of patients with haematological malignancies. METHODS: Clinical data from patients treated with molnupiravir or nirmatrelvir/ritonavir monotherapy for COVID-19 were retrieved from the EPICOVIDEHA registry. Patients treated with molnupiravir were matched by sex, age (±10 years), and severity of baseline haematological malignancy to controls treated with nirmatrelvir/ritonavir. RESULTS: A total of 116 patients receiving molnupiravir for the clinical management of COVID-19 were matched to an equal number of controls receiving nirmatrelvir/ritonavir. In each of the groups, 68 (59%) patients were male; with a median age of 64 years (interquartile range [IQR] 53-74) for molnupiravir recipients and 64 years (IQR 54-73) for nirmatrelvir/ritonavir recipients; 56.9% (n=66) of the patients had controlled baseline haematological malignancy, 12.9% (n=15) had stable disease, and 30.2% (n=35) had active disease at COVID-19 onset in each group. During COVID-19 infection, one third of patients from each group were admitted to hospital. Although a similar proportion of patients in the two groups were vaccinated (molnupiravir n=77, 66% vs. nirmatrelvir/ritonavir n=87, 75%), more of those treated with nirmatrelvir/ritonavir had received four vaccine doses (n=27, 23%) compared with those treated with molnupiravir (n=5, 4%) (P<0.001). No differences were detected in COVID-19 severity (P=0.39) or hospitalisation (P=1.0). No statistically significant differences were identified in overall mortality rate (P=0.78) or survival probability (d30 P=0.19, d60 P=0.67, d90 P=0.68, last day of follow up P=0.68). Deaths were either attributed to COVID-19, or the infection was judged by the treating physician to have contributed to death. CONCLUSIONS: Hospitalisation and mortality rates with molnupiravir were comparable to those with nirmatrelvir/ritonavir in high-risk patients with haematological malignancies and COVID-19. Molnupiravir is a plausible alternative to nirmatrelvir/ritonavir for COVID-19 treatment in patients with haematological malignancy.

• MeSH
• antivirové látky terapeutické užití   MeSH
• COVID-19 * MeSH
• farmakoterapie COVID-19 MeSH
• hematologické nádory * komplikace   farmakoterapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• ritonavir terapeutické užití   MeSH
• SARS-CoV-2 MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

OBJECTIVE: This study aims to describe the outcomes of COVID-19 patients treated with molnupiravir and to explore the associations with various risk factors. METHODS: We conducted a single-centre, descriptive, retrospective study without a comparison group. RESULTS: Out of 141 patients, 70 (49.7%) required follow-up outpatient care. In the subgroup of 66 (46.8%) hospitalized patients, 28 (19.9%) developed interstitial viral pneumonia, with 6 (4.3%) deaths. Unvaccinated patients had a higher incidence of pneumonia (p = 0.020), and obesity was a significant risk factor for both pneumonia (p = 0.001) and mortality (p = 0.011). Patients over 60 years (p = 0.040) and those with cardiovascular diseases (p = 0.026) also had increased pneumonia risk. Male sex was associated with a higher risk of death (p = 0.020). CONCLUSION: Molnupiravir treatment was linked to reduced risks of hospitalization and death, particularly in high-risk patients. Vaccination provided additional protection, and obesity obstructive pulmonary disease and autoimmune diseases were significant risk factors for severe outcomes.

• MeSH
• antivirové látky * terapeutické užití   MeSH
• COVID-19 mortalita   epidemiologie   MeSH
• cytidin * analogy a deriváty   terapeutické užití   MeSH
• dospělí MeSH
• farmakoterapie COVID-19 * MeSH
• hospitalizace statistika a číselné údaje   MeSH
• hydroxylaminy terapeutické užití   MeSH
• leucin terapeutické užití   analogy a deriváty   MeSH
• lidé středního věku MeSH
• lidé MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• SARS-CoV-2 MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: We examined the clinical effectiveness of molnupiravir in reducing deaths in a real-world cohort of adult patients with COVID-19 during the Omicron outbreak. METHODS: This was a population-wide retrospective cohort study in the Czech Republic. We analyzed all 74 541 patients with an officially registered diagnosis of SARS-CoV-2 infection between 1 January and 31 December 2022, aged 18 years or older, treated with molnupiravir. The primary outcome was 30-day all-cause mortality; the secondary outcome was 30-day COVID-19-related mortality. Hazard ratios (HRs) were estimated using stratified Cox regression and the Fine-Gray model. RESULTS: The use of molnupiravir in adult SARS-CoV-2 positive patients was associated with a lower risk of both 30-day all-cause mortality: adjusted HR 0.58 (95% confidence interval, 0.53-0.64; P < .001) and 30-day COVID-19-related mortality: adjusted HR 0.50 (95% confidence interval, 0.42-0.58; P < .001). The effect of molnupiravir was highly significant regardless of sex, Deyo-Charlson Comorbidity Index score, hospitalization status, COVID-19 vaccination status, and patients older than age 65 years. CONCLUSIONS: In this cohort study, early initiation of molnupiravir was associated with a significant reduction in 30-day all-cause and COVID-19-related mortality in adult SARS-CoV-2 positive patients.

• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH

Přehledový článek se věnuje nejnovějším strategiím a postupům v léčbě covidu-19 tři roky po jeho prvním výskytu. Důraz je kladen na využití těchto poznatků v medicínské praxi. V roce 2023 je cílená terapie infekce SARS-CoV-2 již založena na výsledcích robustních randomizovaných kontrolovaných studií. V rámci ambulantní péče je na prvním místě vždy nutné vyhodnotit, zda je možná u konkrétního pacienta léčba v domácím prostředí, či by měl být pacient odeslán k hospitalizaci. Pro ambulantně léčené pacienty s lehkým až středně těžkým průběhem covidu-19 dnes máme k dispozici perorální antivirotika nirmatrelvir/ritonavir a molnupiravir. Za hospitalizace zpravidla podáváme remdesivir v intravenózní podobě. U nejzávažnějších případů covidu-19 s hypoxemickým respiračním selháním je na místě podání kortikoidů. U všech pacientů nesmíme zapomínat na riziko tromboembolických komplikací. Klíčovým momentem v boji proti covidu-19 bylo zavedení aktivní imunizace, očkování stále vykazuje velmi dobrou ochranu proti závažnému průběhu covidu-19 a úmrtí.

The overview article mostly deals with the most recent strategies and procedures in covid-19 treatment three years after its first occurrence. Emphasis is put on using this knowledge in medical practice. In the year 2023 the targeted therapy for SARS-CoV-2 infection is based on the results of robust randomized controlled studies. In out-patient setting, the most important is to evaluate whether home treatment is an option for the specific patient or if the patient should be sent for hospitalization. For patients treated in out-patient care with mild or moderate infection of covid-19, today we have perioral antiviral drugs nirmatrelvir/ritonavir and a molnupiravir. During hospitalization we usually administer remdesivir in intravenous form. The most severe cases of covid-19 with hypoxemic respiratory failure benefit from administration of corticosteroids. We must not forget the risk of thromboembolic complications at all patients. Key moment in fight against covid-19 was introduction of active immunization, since vaccination still shows very good protection against severe covid-19 infection and death.

• Klíčová slova
• remdesivir, molnupiravir,
• MeSH
• adenosinmonofosfát analogy a deriváty   aplikace a dávkování   terapeutické užití   MeSH
• antivirové látky MeSH
• COVID-19 komplikace   patologie   MeSH
• farmakoterapie COVID-19 * MeSH
• hormony kůry nadledvin terapeutické užití   MeSH
• hydroxylaminy aplikace a dávkování   terapeutické užití   MeSH
• lidé MeSH
• tromboembolie prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

• Klíčová slova
• molnupiravir,
• MeSH
• antivirové látky * terapeutické užití   MeSH
• COVID-19 * MeSH
• cytidin analogy a deriváty   MeSH
• farmakoterapie COVID-19 MeSH
• hydroxylaminy terapeutické užití   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH