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Sci Rep . Predictors of nirmatrelvir-ritonavir receipt among COVID-19 patients in a large US health system

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  • Sci Rep . Predictors of nirmatrelvir-ritonavir receipt among COVID-19 patients in a large US health system

    Sci Rep


    . 2024 Mar 29;14(1):7485.
    doi: 10.1038/s41598-024-57633-7. Predictors of nirmatrelvir-ritonavir receipt among COVID-19 patients in a large US health system

    Deborah E Malden 1 , John M McLaughlin 2 , Vennis Hong 3 , Joseph Lewnard 4 5 6 , Bradley K Ackerson 3 , Laura Puzniak 2 , Jeniffer S Kim 3 , Harpreet Takhar 3 , Timothy B Frankland 3 , Jeff M Slezak 3 , Sara Y Tartof 7 8



    AffiliationsAbstract

    A clear understanding of real-world uptake of nirmatrelvir-ritonavir for treatment of SARS-CoV-2 can inform treatment allocation strategies and improve interpretation of effectiveness studies. We used data from a large US healthcare system to describe nirmatrelvir-ritonavir dispenses among all SARS-CoV-2 positive patients aged ≥ 12 years meeting recommended National Institutes of Health treatment eligibility criteria for the study period between 1 January and 31 December, 2022. Overall, 10.9% (N = 34,791/319,900) of treatment eligible patients with SARS-CoV-2 infections received nirmatrelvir-ritonavir over the study period. Although uptake of nirmatrelvir-ritonavir increased over time, by the end of 2022, less than a quarter of treatment eligible patients with SARS-CoV-2 infections had received nirmatrelvir-ritonavir. Across patient demographics, treatment was generally consistent with tiered treatment guidelines, with dispenses concentrated among patients aged ≥ 65 years (14,706/63,921; 23.0%), and with multiple comorbidities (10,989/54,431; 20.1%). However, neighborhoods of lower socioeconomic status (upper third of neighborhood deprivation index [NDI]) had between 12% (95% CI: 7-18%) and 28% (25-32%) lower odds of treatment dispense over the time periods studied compared to the lower third of NDI distribution, even after accounting for demographic and clinical characteristics. A limited chart review (N = 40) confirmed that in some cases a decision not to treat was appropriate and aligned with national guidelines to use clinical judgement on a case-by-case basis. There is a need to enhance patient and provider awareness on the availability and benefits of nirmatrelvir-ritonavir for the treatment of COVID-19 illness.


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