tetano
Editor, Senior Moderator
Ther Adv Infect Dis
. 2024 Mar 26:11:20499361241236582.
doi: 10.1177/20499361241236582. eCollection 2024 Jan-Dec. Nirmatrelvir/ritonavir and remdesivir against symptomatic treatment in high-risk COVID-19 outpatients to prevent hospitalization or death during the Omicron era: a propensity score-matched study
Sandra Rajme-López[SUP] 1 [/SUP], Bernardo A Martinez-Guerra[SUP] 1 [/SUP], Carla M Román-Montes[SUP] 1 [/SUP], Karla M Tamez-Torres[SUP] 1 [/SUP], Andrea C Tello-Mercado[SUP] 1 [/SUP], Karen M Tepo-Ponce[SUP] 1 [/SUP], Zurisadai Segura-Ortíz[SUP] 1 [/SUP], Abigail López-Aguirre[SUP] 1 [/SUP], Orianlid Del Rocío Gutiérrez-Mazariegos[SUP] 1 [/SUP], Oswaldo Lazcano-Delgadillo[SUP] 1 [/SUP], Rafael Nares-López[SUP] 1 [/SUP], María F González-Lara[SUP] 1 [/SUP], David Kershenobich-Stalnikowitz[SUP] 2 [/SUP], José Sifuentes-Osornio[SUP] 2 [/SUP], Alfredo Ponce-de-León[SUP] 1 [/SUP], Guillermo M Ruíz-Palacios[SUP] 3 [/SUP]
Affiliations
Background: Even though worldwide death rates from coronavirus disease 2019 (COVID-19) have decreased, the threat of disease progression and death for high-risk groups continues. Few direct comparisons between the available severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antivirals have been made.
Objective: We aimed to compare two SARS-CoV-2 antivirals (nirmatrelvir/ritonavir and remdesivir) against all-cause hospitalization or death.
Design: This is a propensity score-matched cohort study.
Methods: We included all high-risk outpatients with COVID-19 in a tertiary referral center in Mexico City from 1 January 2022 to 31 July 2023. The primary outcome was all-cause hospitalization or death 28 days after symptom onset. The secondary outcome was COVID-19-associated hospitalization or death 28 days after symptom onset. Logistic regression analysis for characteristics associated with the primary outcome and a multi-group comparison with Kaplan-Meier survival estimates were performed.
Results: Of 1566 patients analyzed, 783 did not receive antiviral treatment, 451 received remdesivir, and 332 received nirmatrelvir/ritonavir. The median age was 60 years (interquartile range: 46-72), 62.5% were female and 97.8% had at least one comorbidity. The use of nirmatrelvir/ritonavir was associated with an absolute risk reduction of 8.8% and a relative risk reduction of 90% for all-cause hospitalization or death. The use of remdesivir was associated with an absolute risk reduction of 6.4% and a relative risk reduction of 66% for all-cause hospitalization or death. In multivariable analysis, both antivirals reduced the odds of 28-day all-cause hospitalization or death [nirmatrelvir/ritonavir odds ratio (OR) 0.08 - 95% confidence interval (CI): 0.03-0.19, remdesivir OR 0.29 - 95% CI: 0.18-0.45].
Conclusion: In high-risk COVID-19 outpatients, early antiviral treatment with nirmatrelvir/ritonavir or remdesivir was associated with lower 28-day all-cause hospitalization or death.
Keywords: COVID-19; early treatment; nirmatrelvir/ritonavir; remdesivir.
. 2024 Mar 26:11:20499361241236582.
doi: 10.1177/20499361241236582. eCollection 2024 Jan-Dec. Nirmatrelvir/ritonavir and remdesivir against symptomatic treatment in high-risk COVID-19 outpatients to prevent hospitalization or death during the Omicron era: a propensity score-matched study
Sandra Rajme-López[SUP] 1 [/SUP], Bernardo A Martinez-Guerra[SUP] 1 [/SUP], Carla M Román-Montes[SUP] 1 [/SUP], Karla M Tamez-Torres[SUP] 1 [/SUP], Andrea C Tello-Mercado[SUP] 1 [/SUP], Karen M Tepo-Ponce[SUP] 1 [/SUP], Zurisadai Segura-Ortíz[SUP] 1 [/SUP], Abigail López-Aguirre[SUP] 1 [/SUP], Orianlid Del Rocío Gutiérrez-Mazariegos[SUP] 1 [/SUP], Oswaldo Lazcano-Delgadillo[SUP] 1 [/SUP], Rafael Nares-López[SUP] 1 [/SUP], María F González-Lara[SUP] 1 [/SUP], David Kershenobich-Stalnikowitz[SUP] 2 [/SUP], José Sifuentes-Osornio[SUP] 2 [/SUP], Alfredo Ponce-de-León[SUP] 1 [/SUP], Guillermo M Ruíz-Palacios[SUP] 3 [/SUP]
Affiliations
- PMID: 38545451
- PMCID: PMC10966993
- DOI: 10.1177/20499361241236582
Background: Even though worldwide death rates from coronavirus disease 2019 (COVID-19) have decreased, the threat of disease progression and death for high-risk groups continues. Few direct comparisons between the available severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antivirals have been made.
Objective: We aimed to compare two SARS-CoV-2 antivirals (nirmatrelvir/ritonavir and remdesivir) against all-cause hospitalization or death.
Design: This is a propensity score-matched cohort study.
Methods: We included all high-risk outpatients with COVID-19 in a tertiary referral center in Mexico City from 1 January 2022 to 31 July 2023. The primary outcome was all-cause hospitalization or death 28 days after symptom onset. The secondary outcome was COVID-19-associated hospitalization or death 28 days after symptom onset. Logistic regression analysis for characteristics associated with the primary outcome and a multi-group comparison with Kaplan-Meier survival estimates were performed.
Results: Of 1566 patients analyzed, 783 did not receive antiviral treatment, 451 received remdesivir, and 332 received nirmatrelvir/ritonavir. The median age was 60 years (interquartile range: 46-72), 62.5% were female and 97.8% had at least one comorbidity. The use of nirmatrelvir/ritonavir was associated with an absolute risk reduction of 8.8% and a relative risk reduction of 90% for all-cause hospitalization or death. The use of remdesivir was associated with an absolute risk reduction of 6.4% and a relative risk reduction of 66% for all-cause hospitalization or death. In multivariable analysis, both antivirals reduced the odds of 28-day all-cause hospitalization or death [nirmatrelvir/ritonavir odds ratio (OR) 0.08 - 95% confidence interval (CI): 0.03-0.19, remdesivir OR 0.29 - 95% CI: 0.18-0.45].
Conclusion: In high-risk COVID-19 outpatients, early antiviral treatment with nirmatrelvir/ritonavir or remdesivir was associated with lower 28-day all-cause hospitalization or death.
Keywords: COVID-19; early treatment; nirmatrelvir/ritonavir; remdesivir.