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Ann Med
. 2024 Dec;56(1):2313062.
doi: 10.1080/07853890.2024.2313062. Epub 2024 Feb 14. Associations of nirmatrelvir-ritonavir treatment with death and clinical improvement in hospitalized patients with COVID-19 during the Omicron wave in Beijing, China: a multicentre, retrospective cohort study
Xiaobo Han 1 2 , Chenglong Li 3 4 , Xin Yuan 5 , Junchang Cui 1 2 , Zhihai Han 6 , Jiguang Meng 7 8 , Weiguo Zhao 1 , Fei Xie 9 , Kaifei Wang 9 , Yuhong Liu 1 , Guoxin Muo 1 , Na Xi 10 , Mengli Zheng 1 2 , Rentao Wang 1 2 , Kun Xiao 1 2 , Wei Chen 6 , Junchen Xiong 6 7 , Dahui Zhao 9 , Xinxin Zhang 1 , Xinjie Han 1 , Haibo Cheng 11 , Zhongkuo Yu 1 2 , Yinghan Shi 1 2 , Wuxiang Xie 12 13 , Lixin Xie 1 2
Affiliations
Background: The effectiveness of nirmatrelvir-ritonavir has mainly been shown in non-hospitalized patients with mild-to-moderate coronavirus disease 2019 (COVID-19). The real-world effectiveness of nirmatrelvir-ritonavir urgently needs to be determined using representative in-hospital patients with COVID-19 during the Omicron wave of the pandemic.
Methods: We performed a multicentre, retrospective study in five Chinese PLA General Hospital medical centers in Beijing, China. Patients hospitalized with COVID-19 from 10 December 2022 to 20 February 2023 were eligible for inclusion. A 1:1 propensity score matching was performed between the nirmatrelvir-ritonavir group and the control group.
Results: 1010 recipients of nirmatrelvir-ritonavir and 1010 matched controls were finally analyzed after matching. Compared with matched controls, the nirmatrelvir-ritonavir group had a lower incidence rate of all-cause death (4.6/1000 vs. 6.3/1000 person-days, p = 0.013) and a higher incidence rate of clinical improvement (47.6/1000 vs. 45.8/1000 person-days, p = 0.012). Nirmatrelvir-ritonavir was associated with a 22% lower all-cause mortality and a 14% higher incidence of clinical improvement. Initiation of nirmatrelvir-ritonavir within 5 days after symptom onset was associated with a 50% lower mortality and a 26% higher clinical improvement rate. By contrast, no significant associations were identified among patients receiving nirmatrelvir-ritonavir treatment more than 5 days after symptom onset. Nirmatrelvir-ritonavir was also associated with a 50% increase in survival days and a 12% decrease in days to clinical improvement.
Conclusion: Among hospitalized patients with COVID-19 during the Omicron wave in Beijing, China, the early initiation of nirmatrelvir-ritonavir was associated with clinical benefits of lowering mortality and improving clinical recovery.
Keywords: Covid-19; all-cause death; clinical improvement; nirmatrelvir-ritonavir; off-label treatment; real-world.
. 2024 Dec;56(1):2313062.
doi: 10.1080/07853890.2024.2313062. Epub 2024 Feb 14. Associations of nirmatrelvir-ritonavir treatment with death and clinical improvement in hospitalized patients with COVID-19 during the Omicron wave in Beijing, China: a multicentre, retrospective cohort study
Xiaobo Han 1 2 , Chenglong Li 3 4 , Xin Yuan 5 , Junchang Cui 1 2 , Zhihai Han 6 , Jiguang Meng 7 8 , Weiguo Zhao 1 , Fei Xie 9 , Kaifei Wang 9 , Yuhong Liu 1 , Guoxin Muo 1 , Na Xi 10 , Mengli Zheng 1 2 , Rentao Wang 1 2 , Kun Xiao 1 2 , Wei Chen 6 , Junchen Xiong 6 7 , Dahui Zhao 9 , Xinxin Zhang 1 , Xinjie Han 1 , Haibo Cheng 11 , Zhongkuo Yu 1 2 , Yinghan Shi 1 2 , Wuxiang Xie 12 13 , Lixin Xie 1 2
Affiliations
- PMID: 38354691
- DOI: 10.1080/07853890.2024.2313062
Background: The effectiveness of nirmatrelvir-ritonavir has mainly been shown in non-hospitalized patients with mild-to-moderate coronavirus disease 2019 (COVID-19). The real-world effectiveness of nirmatrelvir-ritonavir urgently needs to be determined using representative in-hospital patients with COVID-19 during the Omicron wave of the pandemic.
Methods: We performed a multicentre, retrospective study in five Chinese PLA General Hospital medical centers in Beijing, China. Patients hospitalized with COVID-19 from 10 December 2022 to 20 February 2023 were eligible for inclusion. A 1:1 propensity score matching was performed between the nirmatrelvir-ritonavir group and the control group.
Results: 1010 recipients of nirmatrelvir-ritonavir and 1010 matched controls were finally analyzed after matching. Compared with matched controls, the nirmatrelvir-ritonavir group had a lower incidence rate of all-cause death (4.6/1000 vs. 6.3/1000 person-days, p = 0.013) and a higher incidence rate of clinical improvement (47.6/1000 vs. 45.8/1000 person-days, p = 0.012). Nirmatrelvir-ritonavir was associated with a 22% lower all-cause mortality and a 14% higher incidence of clinical improvement. Initiation of nirmatrelvir-ritonavir within 5 days after symptom onset was associated with a 50% lower mortality and a 26% higher clinical improvement rate. By contrast, no significant associations were identified among patients receiving nirmatrelvir-ritonavir treatment more than 5 days after symptom onset. Nirmatrelvir-ritonavir was also associated with a 50% increase in survival days and a 12% decrease in days to clinical improvement.
Conclusion: Among hospitalized patients with COVID-19 during the Omicron wave in Beijing, China, the early initiation of nirmatrelvir-ritonavir was associated with clinical benefits of lowering mortality and improving clinical recovery.
Keywords: Covid-19; all-cause death; clinical improvement; nirmatrelvir-ritonavir; off-label treatment; real-world.