Treatment

COVID-19 Roundup: Hospitalization Risks, Molnupiravir, Blood Clot Risks, Fluvoxamine

Vaccination and Hospitalization1

Vaccination against COVID-19 in adults who were previously infected with the virus may be associated with additional protection against COVID-19-related hospitalization.

Researchers used the Cosmos electronic health record data to compare vaccination statuses of 3761 individuals with prior COVID-19 infection, with 7522 control patients without prior infection.

The results indicated that during the delta variant predominant period (June 20, 2021, to December 18, 2021) the estimated vaccine effectiveness (VE) against hospitalization was 47.5% for 2 vaccine doses, and 57.8% for a booster dose. During the omicron variant predominant period (December 19, 2021, to February 24, 2022) the VE was 34.6%, and 67.6%, respectively.

Researchers concluded that all eligible persons, regardless of prior COVID-19 infection, should stay up to date with vaccination.

Molnupiravir2

Individuals treated with molnupiravir may have better outcomes for most COVID-19 symptoms than those treated with placebo, according to a new analysis.

Included were 709 individuals who randomly received molnupiravir and 699 individuals who received placebo. All individuals completed daily questionnaires on COVID-19-related symptoms for 29 days.

Sustained improvement or resolution of symptoms was more likely to occur in the molnupiravir group than the placebo group. The loss of smell and fatigue had the greatest observed benefit. Symptom progression was less likely to occur in the molnupiravir group, and this group was more likely to obtain sustained improvement and remission by days 3, 5, and 10.

Blood Clot Risks3

Individuals who were infected with COVID-19 may be at an increased risk for deep vein thrombosis, pulmonary embolism, and bleeding events in the months following infection, according to the results of a matched cohort study.

A total of 1,057,174 participants in Sweden who tested positive for COVID-19 between February 1, 2020, and May 25, 2021, were included. The COVID-19 group was compared to 4,076,342 control individuals that were matched by age, sex, and country of residence.

The incidence rate ratios were increased for 70 days after COVID-19 for deep vein thrombosis, 110 days for pulmonary embolism, and 60 days for bleeding. Further, the incidence rate ratio during the first 30 days after COVID-19 were 5.90, 31.59, and 2.48, respectively. The risk ratios during the first 30 days after COVID-19 were 4.98, 33.05, and 1.88, respectively.

Researchers noted varying limitations, including that this is an observational study, so cause cannot be established. In addition, venous thromboembolism may have been underdiagnosed in individuals with COVID-19, testing for covid-19 was limited (especially during the initial pandemic wave), and information on vaccination was not yet available.

Fluvoxamine Treatment4

The early, outpatient use of fluvoxamine in symptomatic adults with COVID-19 may reduce hospitalizations.

“In this systematic review and meta-analysis of data from 3 trials, under a variety of assumptions, fluvoxamine showed a high probability of being associated with reduced hospitalization in outpatients with COVID-19,” researchers concluded.

“Ongoing randomized trials are important to evaluate alternative doses, explore the effectiveness in vaccinated patients, and provide further refinement to these estimates. Meanwhile, fluvoxamine could be recommended as a management option, particular inn resource-limited settings or for individuals without access to SARS-CoV-2 monoclonal antibody therapy or direct antivirals.”

 

—Leigh Precopio

 

References:

  1. Plumb ID, Feldstein LR, Barkley E, et al. Effectiveness of COVID-19 mRNA vaccination in preventing COVID-19-associated hospitalization among adults with previous SARS-CoV-2 infection – United States, June 2021 – February 2022. MMWR Morb Mortal Wkly Rep. 2022;71(15):549-555. doi:10.15585/mmwr.mm7115e2
  2. Guan Y. Impact of molnupiravir treatment on patient-reported COVID-19 symptoms in the MOVe-OUT study. Paper presented at: European Congress of Clinical Microbiology and Infectious Diseases; April 23-26, 2022; Lisbon, Portugal.
  3. Katsoularis I, Fonseca-Rodríguez O, Farrington P, et al. Risks of deep vein thrombosis, pulmonary embolism, and bleeding after COVID-19: nationwide self-controlled case series and matched cohort study. BMJ. 2022;376:e069590. doi:10.1136/bmj-2021-069590
  4. Lee TC, Vigod S, Bortolussi-Courval E, et al. Fluvoxamine for outpatient management of COVID-19 to prevent hospitalization: a systematic review and meta-analysis. JAMA Netw Open. 2022;5(4):e226269. doi:10.1001/jamanetworkopen.2022.6269