Efficacy and safety of Paxlovid for COVID-19:a meta-analysis

Zheng, Qian; Ma, Pengfei; Wang, Mingwei; Chen, Yongran; Zhou, Mengyun; Ye, Lan; Feng, Zhanhui; Zhang, Chunlin

doi:10.1016/j.jinf.2022.09.027

Cited by 65 publications

(63 citation statements)

References 12 publications

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“…A recent meta-analysis attempted to summarize the safety and effectiveness of nirmatrelvir/ritonavir from published trials and observational studies and reported an OR of death and hospitalization of 0.22 (95%CI, 0.11-0.45) with no safety concerns. (18) A cohort study from Israel identified an adjusted hazard ratio for severe COVID-19 in patients 65 years of age or older of 0.27 (95%CI: 0.15-0.49), but only 0.74 (95%CI: 0.35-1.58) in those 40-64 years of age. Their findings were similar when further stratified by previous immunity to SARS-CoV-2.…”

Section: Discussionmentioning

confidence: 99%

Real-world effectiveness of nirmatrelvir/ritonavir use for COVID-19: A population-based cohort study in Ontario, Canada

Schwartz

Wang

Tadrous

et al. 2022

Preprint

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Background: Our objective was to evaluate the real world effectiveness of nirmatrelvir/ritonavir to prevent severe COVID-19 while Omicron and its subvariants predominate. Methods: We conducted a population based cohort study in Ontario, Canada including all residents >17 years of age who tested positive for SARS-CoV-2 by PCR between 4 April and 31 August 2022. We compared nirmatrelvir/ritonavir treated patients to unexposed patients and measured the primary outcome of hospitalization or death from COVID-19, and a secondary outcome of death 1-30 days. We used weighted logistic regression to calculate weighted odds ratios (wOR) with 95% confidence intervals (CIs) using inverse probability of treatment weighting (IPTW) to control for confounding. Results: The final cohort included 177,545 patients with 8,876 (5.0%) exposed and 168,669 (95.0%) unexposed individuals. The groups were well balanced with respect to demographic and clinical characteristics after applying stabilized IPTW. Hospitalization or death within 30 days was lower in the nirmatrelvir/ritonavir treated group compared to unexposed individuals (2.1% vs 3.7%, wOR 0.56; 95%CI, 0.47-0.67). In the secondary analysis, the relative odds of death was also significantly reduced (1.6% vs 3.3%, wOR 0.49; 95%CI, 0.39-0.62). The number needed to treat to prevent one case of severe COVID-19 was 62 (95%CI 43 to 80). Findings were similar across strata of age, DDIs, vaccination status, and comorbidities. Interpretation: Nirmatrelvir/ritonavir was associated with significantly reduced risk of hospitalization and death from COVID-19 in this observational study, supporting ongoing use of this therapeutic to treat patients with mild COVID-19 at risk for severe disease.

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Section: Discussionmentioning

confidence: 99%

Real-world effectiveness of nirmatrelvir/ritonavir use for COVID-19: A population-based cohort study in Ontario, Canada

Schwartz

Wang

Tadrous

et al. 2022

Preprint

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“…We did not have information on the use of Ritonavir-boosted Nirmatrelvir (Paxlovid) available in Quebec since mid-January 2022 for immunosuppressed adults and since mid-March 2022 for individuals ≥60 years with <2 vaccine doses and those up-to-date with vaccination but at higher risk of COVID-19 complications due to comorbidity. 29 Since this medication may also reduce the risk of hospitalisation, failure to take it into account may have also tended to underestimate VE. Although our main analyses included immunocompromised individuals with potentially reduced response to vaccination, they represented only 7% of cases and controls and similar estimates were obtained with their exclusion.…”

Section: Discussionmentioning

confidence: 99%

Prior infection- and/or vaccine-induced protection against Omicron BA.1, BA.2 and BA.4/BA.5-related hospitalisations in older adults: a test-negative case-control study in Quebec, Canada

Carazo¹,

Skowronski

Brisson

et al. 2022

Preprint

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Background. Due to severe outcomes, elderly adults 60 years or older are prioritized for COVID-19 vaccination but accumulated SARS-CoV-2 infection and vaccination likely modifies their risk. We estimated vaccine effectiveness against omicron-associated hospitalisation among elderly adults, by number of doses, prior infection history and time since last immunological event. Methods. We conducted a test-negative case-control study among symptomatic elderly adults tested for SARS-CoV-2 in Quebec, Canada during BA.1-, BA.2- and BA.4/5-dominant periods. Relative to unvaccinated, infection-naive participants, we compared COVID-19 hospitalisation risk by mRNA vaccine dose and/or prior infection (pre-omicron or omicron) history. Findings. During BA.1, BA.2 and BA.4/5 periods, two- vs. four-dose vaccine effectiveness alone against hospitalisation was: 78% (95%CI:75-80) vs. 96% (95%CI:93-98); 60% (95%CI:50-97) vs. 84% (95%CI:81-87); and 40% (95%CI:30-49) vs. 68% (95%CI:63-72), respectively, consistent with longer median time since second vs fourth dose. By respective period, effectiveness of pre-omicron vs. omicron infection alone against hospitalisation was: 93% (95%CI:80-97) vs. [not estimable]; 88% (95%CI:50-97) vs. 96% (95%CI:68-99); and 69% (95%CI:30-85) vs. 90% (95%CI:79-95). Regardless of doses (2-5) or prior infection type, hybrid protection was ≥90%, lasting at least 6-8 months during the BA.4/5 period. Prior omicron infection alone reduced BA.4/5 hospitalisation risk by >80% for at least 6-8 months. Interpretation. Elderly adults with history of both prior SARS-CoV-2 infection and ≥2 vaccine doses appear well-protected for a prolonged period against omicron hospitalisation, including BA.4/5. Ensuring infection-naive older adults remain up-to-date with vaccination may further reduce COVID-19 hospitalisations most efficiently. Funding. Ministère de la Santé et des Services sociaux du Québec.

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“…The study indicates that treatment with paxlovid, within five days after diagnosis, produced a reduction in multisystem symptoms (e.g., respiratory tract infections, cardiac arrhythmia, gastrointestinal issues) and complications. Additionally, Zheng et al [ 52 ] indicated that the paxlovid treatment is effective and safe for patients with COVID-19, diminishing both the hospitalization and mortality rate by 78%, and that there was not a significant difference of rebound and adverse effects between the paxlovid-treated and the control groups. Zhong et al [ 53 ] suggested that the administration of paxlovid (300 mg nirmatrelvir and 100 mg ritonavir for 5 days) to elderly Chinese patients infected by the SARS-CoV2 omicron variant reduces the viral nucleic acid shedding time.…”

Section: Antiviral Drugsmentioning

confidence: 99%

Drugs for COVID-19: An Update

et al. 2022

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The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was the seventh known human coronavirus, and it was identified in Wuhan, Hubei province, China, in 2020. It caused the highly contagious disease called coronavirus disease 2019 (COVID-19), declared a global pandemic by the World Health Organization (WHO) on 11 March 2020. A great number of studies in the search of new therapies and vaccines have been carried out in these three long years, producing a series of successes; however, the need for more effective vaccines, therapies and other solutions is still being pursued. This review represents a tracking shot of the current pharmacological therapies used for the treatment of COVID-19.

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Efficacy and safety of Paxlovid for COVID-19:a meta-analysis

Cited by 65 publications

References 12 publications

Real-world effectiveness of nirmatrelvir/ritonavir use for COVID-19: A population-based cohort study in Ontario, Canada

Real-world effectiveness of nirmatrelvir/ritonavir use for COVID-19: A population-based cohort study in Ontario, Canada

Prior infection- and/or vaccine-induced protection against Omicron BA.1, BA.2 and BA.4/BA.5-related hospitalisations in older adults: a test-negative case-control study in Quebec, Canada

Drugs for COVID-19: An Update

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