Association of Molnupiravir and Nirmatrelvir/Ritonavir With Post-COVID Cardiovascular Diseases: Real-World Cohort Study
Author(s)
Ka Chun Chong, PhD.
Assistant Professor, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
Assistant Professor, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
OBJECTIVES: Individuals with Long COVID are likely at risk for the onset of new cardiovascular diseases (CVD), but no investigations have examined the effectiveness of the antivirals on reducing the risk of CVD in a general population. This study examined the association of molnupiravir and nirmatrelvir/ritonavir with post-COVID cardiovascular diseases using real-world data.
METHODS: This cohort study utilized real-world inpatient records, vaccination, and confirmed COVID-19 case data in Hong Kong. Patients tested positive for SARS-CoV-2 between Mar 16, 2022 and Nov 9, 2023 were included. The treatment groups included patients prescribed molnupiravir and nirmatrelvir/ritonavir, respectively. The study outcomes are the post-acute CVDs such as arrhythmia and ischemic heart disease. Standardized-mortality-ratio weights was applied to balance covariates, and Cox proportional hazards regression was used to examine the associations.
RESULTS: After screening, 14924, 8388, and 18528 patients were included in control, molnupiravir, and nirmatrelvir/ritonavir group, respectively. Patients with COVID-19 who were prescribed nirmatrelvir/ritonavir had lower risks of post-COVID cerebrovascular disorders (hazard ratio [HR], 0.71 [95% confidence interval {CI}, 0.55 to 0.93]), dysrhythmia (HR, 0.66 [95% CI, 0.55 to 0.81], ischemic heart disease (HR, 0.77 [95% CI, 0.62 to 0.97], major adverse cardiac events (HR, 0.72 [95% CI, 0.58 to 0.88], as well as CVD-specific mortality (HR, 0.66 [95% CI, 0.48 to 0.89], compared to those who did not receive any antivirals. Molnupiravir was not associated with a reduction in the risk of any long-term CVD outcomes.
CONCLUSIONS: Nirmatrelvir/ritonavir, but not molnupiravir, was associated with a risk reduction in long-term CVD following a SARS-CoV-2 infection.
METHODS: This cohort study utilized real-world inpatient records, vaccination, and confirmed COVID-19 case data in Hong Kong. Patients tested positive for SARS-CoV-2 between Mar 16, 2022 and Nov 9, 2023 were included. The treatment groups included patients prescribed molnupiravir and nirmatrelvir/ritonavir, respectively. The study outcomes are the post-acute CVDs such as arrhythmia and ischemic heart disease. Standardized-mortality-ratio weights was applied to balance covariates, and Cox proportional hazards regression was used to examine the associations.
RESULTS: After screening, 14924, 8388, and 18528 patients were included in control, molnupiravir, and nirmatrelvir/ritonavir group, respectively. Patients with COVID-19 who were prescribed nirmatrelvir/ritonavir had lower risks of post-COVID cerebrovascular disorders (hazard ratio [HR], 0.71 [95% confidence interval {CI}, 0.55 to 0.93]), dysrhythmia (HR, 0.66 [95% CI, 0.55 to 0.81], ischemic heart disease (HR, 0.77 [95% CI, 0.62 to 0.97], major adverse cardiac events (HR, 0.72 [95% CI, 0.58 to 0.88], as well as CVD-specific mortality (HR, 0.66 [95% CI, 0.48 to 0.89], compared to those who did not receive any antivirals. Molnupiravir was not associated with a reduction in the risk of any long-term CVD outcomes.
CONCLUSIONS: Nirmatrelvir/ritonavir, but not molnupiravir, was associated with a risk reduction in long-term CVD following a SARS-CoV-2 infection.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH23
Topic
Clinical Outcomes, Epidemiology & Public Health, Health Service Delivery & Process of Care
Topic Subcategory
Public Health, Safety & Pharmacoepidemiology
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Infectious Disease (non-vaccine), Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)