Comparative Effectiveness of Molnupiravir and Nirmatrelvir-Ritonavir for COVID-19 Patients with Type 2 Diabetes

Strategic Insights -

Researchers have compared the effectiveness of molnupiravir and nirmatrelvir-ritonavir for non-hospitalized and hospitalized COVID-19 patients with type 2 diabetes (T2DM) using territory-wide electronic health records in Hong Kong. The study, published in the journal Diabetes, Obesity and Metabolism, found that the use of nirmatrelvir-ritonavir may be preferred to molnupiravir for COVID-19 patients with T2DM and without contraindication to either treatment. The research was supported by the Health And Medical Research Fund and the University Grants Committee.

Key Takeaways:

  • The study compared the effectiveness of molnupiravir and nirmatrelvir-ritonavir for non-hospitalized and hospitalized COVID-19 patients with T2DM using a sequential trial approach.
  • The researchers analyzed data from 16 March 2022 to 31 December 2022 and found that nirmatrelvir-ritonavir initiators were matched with molnupiravir initiators using one-to-one propensity-score matching.
  • The study concluded that the risk of outcomes was compared between groups by Cox regression adjusted for baseline characteristics, and subgroup analyses were performed on age.
  • The researchers found that the use of nirmatrelvir-ritonavir may be preferred to molnupiravir for COVID-19 patients with T2DM and without contraindication to either treatment.
  • Eric Y. F. Wan, Centre for Safe Medication Practice and research, led the research, which included additional authors Zoey C. T. Wong, Vincent K. C. Yan, Celine S. L. Chui, Francisco T. T. Lai, Xue Li, Ian C. K. Wong, and Esther W. Y. Chan.
  • The study identified 1,474 patients aged 18 years or older with T2DM and COVID-19 infection, who received molnupiravir or nirmatrelvir-ritonavir within 5 days of infection.

Statistics:

  • A total of 1,474 patients were included in the study, with 742 receiving molnupiravir and 732 receiving nirmatrelvir-ritonavir.
  • The study concluded that the use of nirmatrelvir-ritonavir may be preferred to molnupiravir for COVID-19 patients with T2DM and without contraindication to either treatment.
  • The median follow-up was 28 days.
  • The study was published in Diabetes, Obesity and Metabolism, a journal published by Wiley.

Sources:

  • NewsRx. New Findings from Department of Pharmacology and Pharmacy in the Area of COVID-19 Described (Comparing the effectiveness of molnupiravir and nirmatrelvir-ritonavir in non-hospitalized and hospitalized COVID -19 patients with type 2 ...). Medical Letter on the CDC & FDA. November 2, 2025; p 387.
  • Comparing the effectiveness of molnupiravir and nirmatrelvir-ritonavir in non-hospitalized and hospitalized COVID-19 patients with type 2 diabetes: A target trial emulation study. Diabetes, Obesity and Metabolism, 2024,26(10).