Characteristics and outcomes of US Veterans at least 65 years of age at high risk of severe SARS-CoV-2 infection with or without receipt of oral antiviral agents

•Molnupiravir and nirmatrelvir/ritonavir demonstrated favorable outcomes in randomized, controlled trials for patients at high risk of progression to severe SARS-CoV-2 infection, but data regarding patients 65 years and older were limited. Given the large number of precautions and contraindications to nirmatrelvir/ritonavir, older patients with high levels of comorbidities and high pill burdens may more often be selected for treatment with molnupiravir.•Our study's primary purpose was to compare outcomes of United States (US) Veterans 65 years of age and older who received either molnupiravir or nirmatrelvir/ritonavir with a propensity-matched group of Veterans 65 years of age and older who did not receive an antiviral agent in the first several weeks after emergency use authorization.•Our study also sought to characterize baseline differences between United States (US) Veterans 65 years and older who received molnupiravir, nirmatrelvir/ritonavir, or no antiviral drug.•The composite primary outcome of admission or death within 30 days of diagnosis was reached less often in those receiving either molnupiravir or nirmatrelvir/ritonavir versus those that received no antiviral (65/1370 [4.75%] vs. 139/1370 [10.2%]; odds ratio 0.44, 95% confidence interval 0.32-0.60, p