Population-based evaluation of the effectiveness of nirmatrelvir–ritonavir for reducing hospital admissions and mortality from COVID-19

A randomized controlled trial involving a high-risk, unvaccinated population that was conducted before the Omicron variant emerged found that nirmatrelvir–ritonavir was effective in preventing progression to severe COVID-19. Our objective was to evaluate the effectiveness of nirmatrelvir–ritonavir i...

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Bibliographic Details
Published in:Canadian Medical Association journal (CMAJ) Vol. 195; no. 6; pp. E220 - E226
Main Authors: Schwartz, Kevin L., Wang, Jun, Tadrous, Mina, Langford, Bradley J., Brown, Kevin A., Daneman, Nick, Leung, Valerie, Gomes, Tara, Friedman, Lindsay, Daley, Peter
Format: Journal Article
Language:English
Published: Canada Elsevier Inc 13.02.2023
CMA Impact Inc
CMA Impact, Inc
Subjects:
Admission and discharge
Age
Analysis
Antiretroviral drugs
Antiviral agents
Antiviral Agents - therapeutic use
Antiviral drugs
Bias
Clinical trials
Cohort analysis
Cohort Studies
Comorbidity
Coronaviruses
COVID-19
COVID-19 Drug Treatment
COVID-19 vaccines
Disease susceptibility
Dosage and administration
Drug dosages
Drug interactions
Drug therapy, Combination
Health insurance
Hospital care
Hospitalization
Hospitals
Humans
Internal Medicine
Pharmacy
Polymerase chain reaction
Population
Protease inhibitors
Ritonavir - therapeutic use
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
Statistics
Testing
Vaccination
Canada
Ontario
ISSN:0820-3946, 1488-2329, 1488-2329
Online Access:Get full text
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Summary:A randomized controlled trial involving a high-risk, unvaccinated population that was conducted before the Omicron variant emerged found that nirmatrelvir–ritonavir was effective in preventing progression to severe COVID-19. Our objective was to evaluate the effectiveness of nirmatrelvir–ritonavir in preventing severe COVID-19 while Omicron and its subvariants predominate. We conducted a population-based cohort study in Ontario that included all residents who were older than 17 years of age and had a positive polymerase chain reaction test for SARS-CoV-2 between Apr. 4 and Aug. 31, 2022. We compared patients treated with nirmatrelvir–ritonavir with patients who were not treated and measured the primary outcome of hospital admission from COVID-19 or all-cause death at 1–30 days, and a secondary outcome of all-cause death. We used weighted logistic regression to calculate weighted odds ratios (ORs) with confidence intervals (CIs) using inverse probability of treatment weighting (IPTW) to control for confounding. The final cohort included 177 545 patients, 8876 (5.0%) who were treated with nirmatrelvir–ritonavir and 168 669 (95.0%) who were not treated. The groups were well balanced with respect to demographic and clinical characteristics after applying stabilized IPTW. We found that the occurrence of hospital admission or death was lower in the group given nirmatrelvir–ritonavir than in those who were not (2.1% v. 3.7%; weighted OR 0.56, 95% CI 0.47–0.67). For death alone, the weighted OR was 0.49 (95% CI 0.39–0.62). Our findings were similar across strata of age, drug–drug interactions, vaccination status and comorbidities. The number needed to treat to prevent 1 case of severe COVID-19 was 62 (95% CI 43–80), which varied across strata. Nirmatrelvir–ritonavir was associated with significantly reduced odds of hospital admission and death from COVID-19, which supports use to treat patients with mild COVID-19 who are at risk for severe disease.
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ISSN:0820-3946
1488-2329
1488-2329
DOI:10.1503/cmaj.221608