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Virol J . Viral kinetics in adults with Covid-19 treated with nirmatrelvir-ritonavir or molnupiravir: a population-based, observational cohort stud

tetano

Editor, Senior Moderator
Virol J


. 2026 Jan 10.
doi: 10.1186/s12985-025-03057-2. Online ahead of print. Viral kinetics in adults with Covid-19 treated with nirmatrelvir-ritonavir or molnupiravir: a population-based, observational cohort study

Marlene Prager[SUP] 1 [/SUP], Dominik Ensle[SUP] 2 [/SUP], Hubert Eser[SUP] 3 [/SUP], Florentin Glötzl[SUP] 4 [/SUP], Benjamin Riedl[SUP] 5 [/SUP], Marton Szell[SUP] 6 [/SUP], Arschang Valipour[SUP] 7 [/SUP], Alexander Zoufaly[SUP] 8 [/SUP], Christoph Wenisch[SUP] 8 [/SUP], Doris Haider[SUP] 9 [/SUP], Heinz Burgmann[SUP] 10 [/SUP], Florian Thalhammer[SUP] 11 [/SUP], Florian Götzinger[SUP] 12 [/SUP], Bernd Jilma[SUP] 1 [/SUP], Ursula Karnthaler[SUP] 2 [/SUP], Markus Zeitlinger[SUP] 13 [/SUP], Anselm Jorda[SUP] 1 [/SUP]



Affiliations
Free article Abstract

Background: This research was motivated by the widespread use of oral antivirals during the Covid-19 pandemic and the remaining uncertainty regarding their effects on viral kinetics, which have rarely been studied in real-world population cohorts of this size.
Methods: We analysed 291,340 SARS-CoV-2 cycle threshold (CT) values from 113,399 non-hospitalized adult patients in Vienna (01/2022-05/2023), including 30,451 from 12,166 nirmatrelvir-ritonavir recipients, 27,959 from 10,752 molnupiravir recipients, and 232,930 from 90,481 untreated controls.
Results: Both antivirals initially caused a rapid increase in mean CT values. After completion of the 5-day treatment course, CT values declined in both antiviral groups, which was not observed in untreated individuals.
Conclusions: These findings provide population-level evidence on post-treatment viral kinetics of oral antivirals during the Omicron wave.

Keywords: Coronavirus; Lagevrio; Paxlovid; SARS-CoV-2; Viral rebound.

 
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