Nirmatrelvir-Ritonavir Reduces Risk of COVID-19 Hospitalization, Death, Study Finds

Nirmatrelvir-ritonavir (Paxlovid) was found to improve a host of outcomes among patients with COVID-19 in a meta-analysis published in Reviews in Medical Virology. The findings add to a growing body of evidence on the safety and efficacy of nirmatrelvir-ritonavir for COVID-19.

The onset of the COVID-19 pandemic put a tremendous strain on medical resources and the health care system. Since the release of the initial COVID-19 vaccine, doctors have continued paying careful attention to the most efficient and useful practices and medications to treat their patients. Nirmatrelvir-ritonavir has received lots of attention as a new drug being administered for the management of COVID-19 and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Nirmatrelvir drastically affects the life cycle and replication of SARS-CoV-2,and ritonavir slows the metabolism of nirmatrelvir. Many studies have previously investigated the safety and efficacy of nirmatrelvir-ritonavir; however, the results have not shown any statistically significant evidence suggesting that nirmatrelvir-ritonavir reduces the risk of intensive care unit (ICU) admission or emergency department (ED) visits. Considering this gap in knowledge, the new study found that using nirmatrelvir-ritonavir to treat COVID-19 may also improve these patient outcomes.

Researchers gathered articles from various databases to examine patients with a clinical COVID-19 diagnosis. Cases were examined regardless of the patient’s age, race, sex, or previous health status. Articles published between January 1, 2020 and January 1, 2023 were separated into 2 groups: an experimental group (patients who used nirmatrelvir-ritonavir) and a control group (patients who used placebos or drugs other than nirmatrelvir-ritonavir).

Death, hospitalization, and death or hospitalization were 3 primary outcomes researchers examined. Others included ICU admission, ED visits, rebound, extra oxygen requirement, and any adverse events (AE). A total of 42 articles largely across the United States, China and Italy were used, which included 79 studies—most were observational, although 4 clinical trials were included.

The results showed that nirmatrelvir-ritonavir can dramatically reduce incidences of death (OR, 0.36; 95% CI, 0.26-0.49; P < .00001), hospitalization (OR, 0.46; 95% CI, 0.32-0.66; P < .0001), and death or hospitalization (OR, 0.44; 95% CI, 0.33-0.60; P < .00001). Nirmatrelvir-ritonavir also demonstrated the ability to significantly lower the occurrence of ICU admission (OR, 0.29; 95% CI, 0.11-0.79; P = .02), ED visits (OR, 0.76; 95% CI, 0.64-0.90; P = .002), and extra oxygen requirements (OR, 0.65; 95% CI, 0.49–0.85; P = .002).

The findings lacked statistically signifiant evidence that nirmatrelvir-ritonavir contributes to higher risks of patient rebound or that patients taking nirmatrelvir-ritonavir need to be extra mindful of adverse events.

The authors listed several limitations in their study, including that some original articles’ study outcomes were missing necessary information. These insufficiencies prevented further subgroup analyses from being conducted because crucial information such as patient age, infection, and immunization histories were unavailable. Additionally, some clinical trials were vulnerable to bias since they were not randomized.

Considering these limitations, authors concluded by stating that more in-depth, quality studies should be conducted to gain a more confident and well-rounded sense of the effects of nirmatrelvir-ritonavir on COVID-19.

Reference

Tian H, Yang C, Song T, et al. Efficacy and safety of paxlovid (nirmatrelvir/ritonavir) in the treatment of COVID-19: an updated meta-analysis and trial sequential analysis. Rev Med Viro. Published online July 23, 2023 doi:10.1002/rmv.2473