Efficacy of molnupiravir and sotrovimab in Japanese dialysis patients with COVID-19 in clinical practice during the Omicron (BA.1 and BA.2) pandemic

Kan Kikuchi; Masaomi Nangaku; Munekazu Ryuzaki; Tomoyuki Yamakawa; Yoshihiro Ota; Norio Hanafusa; Ken Sakai; Yoshihiko Kanno; Ryoichi Ando; Toshio Shinoda; Shu Wakino; Hidetomo Nakamoto; Yoshiaki Takemoto; Tadao Akizawa; COVID-19 Task Force Committee of the Japanese Association of Dialysis Physicians, the Japanese Society for Dialysis Therapy, and the Japanese Society of Nephrology

doi:10.1111/1744-9987.14033

Efficacy of molnupiravir and sotrovimab in Japanese dialysis patients with COVID-19 in clinical practice during the Omicron (BA.1 and BA.2) pandemic

Ther Apher Dial. 2023 Dec;27(6):1064-1069. doi: 10.1111/1744-9987.14033. Epub 2023 Jul 3.

Authors

Kan Kikuchi¹, Masaomi Nangaku², Munekazu Ryuzaki³, Tomoyuki Yamakawa⁴, Yoshihiro Ota⁵, Norio Hanafusa⁶, Ken Sakai⁷, Yoshihiko Kanno⁸, Ryoichi Ando⁹, Toshio Shinoda¹⁰, Shu Wakino¹¹, Hidetomo Nakamoto¹², Yoshiaki Takemoto¹³, Tadao Akizawa¹⁴; COVID-19 Task Force Committee of the Japanese Association of Dialysis Physicians, the Japanese Society for Dialysis Therapy, and the Japanese Society of Nephrology

Affiliations

¹ Division of Nephrology, Shimoochiai Clinic, Tokyo, Japan.
² Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
³ Department of Nephrology, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
⁴ Kidney Center, Shirasagi Hospital, Osaka, Japan.
⁵ Nagoya Memorial Hospital, Nagoya, Japan.
⁶ Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan.
⁷ Department of Nephrology, Toho University Faculty of Medicine, Tokyo, Japan.
⁸ Department of Nephrology, Tokyo Medical University, Tokyo, Japan.
⁹ Department of Nephrology, Medical Group Ishikawa, Tokyo, Japan.
¹⁰ Advanced Course for Clinical Engineering, Teikyo University Junior College, Tokyo, Japan.
¹¹ Department of Nephrology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan.
¹² Department of General Internal Medicine, Saitama Medical University, Saitama, Japan.
¹³ Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
¹⁴ Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.

PMID: 37395555
DOI: 10.1111/1744-9987.14033

Abstract

Introduction: In the present study, the efficacy of sotrovimab and molnupiravir in dialysis patients with COVID-19 was investigated using a registry of COVID-19 in Japanese dialysis patients.

Methods: Dialysis patients with confirmed SARS-CoV-2 during the COVID-19 (Omicron BA.1 and BA.2) pandemic were analyzed. Patients were classified into four treatment groups: molnupiravir monotherapy (molnupiravir group), sotrovimab monotherapy (sotrovimab group), molnupiravir and sotrovimab combination therapy (combination group), and no antiviral therapy (control group). The mortality rates in the four groups were compared.

Results: A total of 1480 patients were included. The mortality of the molnupiravir, sotrovimab, and combination groups were significantly improved compared to the control group (p < 0.001). Multivariate analysis indicated that antiviral therapy improves the survival of dialysis patients with COVID-19 (hazard ratio was 0.184 for molnupiravir, 0.389 for sotrovimab, and 0.254 for combination groups, respectively).

Conclusion: Sotrovimab showed efficacy in Omicron BA.1 but attenuated in BA.2. Molnupiravir also showed efficacy in BA.2, suggesting administration of molnupiravir would be important.

Keywords: COVID-19; SARS-CoV-2; dialysis patients; molnupiravir; sotrovimab.

MeSH terms

Antiviral Agents* / therapeutic use
COVID-19 Drug Treatment
COVID-19* / therapy
East Asian People
Humans
Pandemics
Renal Dialysis
SARS-CoV-2

Substances

molnupiravir
sotrovimab
Antiviral Agents