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Effectiveness of nirmatrelvir–ritonavir in preventing hospital admissions and deaths in people with COVID-19: a cohort study in a large US health-care system

BACKGROUND: In the USA, oral nirmatrelvir–ritonavir is authorised for use in patients aged 12 years or older with mild-to-moderate COVID-19 who are at risk of progression to severe disease and hospitalisation. We aimed to establish the effectiveness of nirmatrelvir–ritonavir in preventing hospital a...

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Autores principales: Lewnard, Joseph A, McLaughlin, John M, Malden, Debbie, Hong, Vennis, Puzniak, Laura, Ackerson, Bradley K, Lewin, Bruno J, Kim, Jeniffer S, Shaw, Sally F, Takhar, Harpreet, Jodar, Luis, Tartof, Sara Y
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Author(s). Published by Elsevier Ltd. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10081864/
https://www.ncbi.nlm.nih.gov/pubmed/36933565
http://dx.doi.org/10.1016/S1473-3099(23)00118-4
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author Lewnard, Joseph A
McLaughlin, John M
Malden, Debbie
Hong, Vennis
Puzniak, Laura
Ackerson, Bradley K
Lewin, Bruno J
Kim, Jeniffer S
Shaw, Sally F
Takhar, Harpreet
Jodar, Luis
Tartof, Sara Y
author_facet Lewnard, Joseph A
McLaughlin, John M
Malden, Debbie
Hong, Vennis
Puzniak, Laura
Ackerson, Bradley K
Lewin, Bruno J
Kim, Jeniffer S
Shaw, Sally F
Takhar, Harpreet
Jodar, Luis
Tartof, Sara Y
author_sort Lewnard, Joseph A
collection PubMed
description BACKGROUND: In the USA, oral nirmatrelvir–ritonavir is authorised for use in patients aged 12 years or older with mild-to-moderate COVID-19 who are at risk of progression to severe disease and hospitalisation. We aimed to establish the effectiveness of nirmatrelvir–ritonavir in preventing hospital admissions and death in people with COVID-19 in an outpatient prescribing context in the USA. METHODS: In this matched observational outpatient cohort study in the Kaiser Permanente Southern California (CA, USA) health-care system, data were extracted from electronic health records of non-hospitalised patients aged 12 years or older who received a positive SARS-CoV-2 PCR test result (their index test) between April 8 and Oct 7, 2022, and had not received another positive test result within the preceding 90 days. We compared outcomes between people who received nirmatrelvir–ritonavir and those who did not receive nirmatrelvir–ritonavir by matching cases by date, age, sex, clinical status (including care received, the presence or absence of acute COVID-19 symptoms at testing, and time from symptom onset to testing), vaccination history, comorbidities, health-care seeking during the previous year, and BMI. Our primary endpoint was the estimated effectiveness of nirmatrelvir–ritonavir in preventing hospital admissions or death within 30 days of a positive test for SARS-CoV-2. FINDINGS: 7274 nirmatrelvir–ritonavir recipients and 126 152 non-recipients with positive SARS-CoV-2 tests were included in our study. 5472 (75·2%) treatment recipients and 84 657 (67·1%) non-recipients were tested within 5 days of symptom onset. Nirmatrelvir–ritonavir had an overall estimated effectiveness of 53·6% (95% CI 6·6–77·0) in preventing hospital admission or death within 30 days of a positive test for SARS-CoV-2, which increased to 79·6% (33·9–93·8) when nirmatrelvir–ritonavir was dispensed within 5 days of symptom onset. Within the subgroup of patients tested within 5 days of symptom onset and whose treatment was dispensed on the day of their test, the estimated effectiveness of nirmatrelvir–ritonavir was 89·6% (50·2–97·8). INTERPRETATION: In a setting with high levels of COVID-19 vaccine uptake, nirmatrelvir–ritonavir effectively reduced the risk of hospital admission or death within 30 days of a positive outpatient SARS-CoV-2 test. FUNDING: US Centers for Disease Control and Prevention and US National Institutes of Health.
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spelling pubmed-100818642023-04-10 Effectiveness of nirmatrelvir–ritonavir in preventing hospital admissions and deaths in people with COVID-19: a cohort study in a large US health-care system Lewnard, Joseph A McLaughlin, John M Malden, Debbie Hong, Vennis Puzniak, Laura Ackerson, Bradley K Lewin, Bruno J Kim, Jeniffer S Shaw, Sally F Takhar, Harpreet Jodar, Luis Tartof, Sara Y Lancet Infect Dis Articles BACKGROUND: In the USA, oral nirmatrelvir–ritonavir is authorised for use in patients aged 12 years or older with mild-to-moderate COVID-19 who are at risk of progression to severe disease and hospitalisation. We aimed to establish the effectiveness of nirmatrelvir–ritonavir in preventing hospital admissions and death in people with COVID-19 in an outpatient prescribing context in the USA. METHODS: In this matched observational outpatient cohort study in the Kaiser Permanente Southern California (CA, USA) health-care system, data were extracted from electronic health records of non-hospitalised patients aged 12 years or older who received a positive SARS-CoV-2 PCR test result (their index test) between April 8 and Oct 7, 2022, and had not received another positive test result within the preceding 90 days. We compared outcomes between people who received nirmatrelvir–ritonavir and those who did not receive nirmatrelvir–ritonavir by matching cases by date, age, sex, clinical status (including care received, the presence or absence of acute COVID-19 symptoms at testing, and time from symptom onset to testing), vaccination history, comorbidities, health-care seeking during the previous year, and BMI. Our primary endpoint was the estimated effectiveness of nirmatrelvir–ritonavir in preventing hospital admissions or death within 30 days of a positive test for SARS-CoV-2. FINDINGS: 7274 nirmatrelvir–ritonavir recipients and 126 152 non-recipients with positive SARS-CoV-2 tests were included in our study. 5472 (75·2%) treatment recipients and 84 657 (67·1%) non-recipients were tested within 5 days of symptom onset. Nirmatrelvir–ritonavir had an overall estimated effectiveness of 53·6% (95% CI 6·6–77·0) in preventing hospital admission or death within 30 days of a positive test for SARS-CoV-2, which increased to 79·6% (33·9–93·8) when nirmatrelvir–ritonavir was dispensed within 5 days of symptom onset. Within the subgroup of patients tested within 5 days of symptom onset and whose treatment was dispensed on the day of their test, the estimated effectiveness of nirmatrelvir–ritonavir was 89·6% (50·2–97·8). INTERPRETATION: In a setting with high levels of COVID-19 vaccine uptake, nirmatrelvir–ritonavir effectively reduced the risk of hospital admission or death within 30 days of a positive outpatient SARS-CoV-2 test. FUNDING: US Centers for Disease Control and Prevention and US National Institutes of Health. The Author(s). Published by Elsevier Ltd. 2023-07 2023-03-15 /pmc/articles/PMC10081864/ /pubmed/36933565 http://dx.doi.org/10.1016/S1473-3099(23)00118-4 Text en © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Articles
Lewnard, Joseph A
McLaughlin, John M
Malden, Debbie
Hong, Vennis
Puzniak, Laura
Ackerson, Bradley K
Lewin, Bruno J
Kim, Jeniffer S
Shaw, Sally F
Takhar, Harpreet
Jodar, Luis
Tartof, Sara Y
Effectiveness of nirmatrelvir–ritonavir in preventing hospital admissions and deaths in people with COVID-19: a cohort study in a large US health-care system
title Effectiveness of nirmatrelvir–ritonavir in preventing hospital admissions and deaths in people with COVID-19: a cohort study in a large US health-care system
title_full Effectiveness of nirmatrelvir–ritonavir in preventing hospital admissions and deaths in people with COVID-19: a cohort study in a large US health-care system
title_fullStr Effectiveness of nirmatrelvir–ritonavir in preventing hospital admissions and deaths in people with COVID-19: a cohort study in a large US health-care system
title_full_unstemmed Effectiveness of nirmatrelvir–ritonavir in preventing hospital admissions and deaths in people with COVID-19: a cohort study in a large US health-care system
title_short Effectiveness of nirmatrelvir–ritonavir in preventing hospital admissions and deaths in people with COVID-19: a cohort study in a large US health-care system
title_sort effectiveness of nirmatrelvir–ritonavir in preventing hospital admissions and deaths in people with covid-19: a cohort study in a large us health-care system
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10081864/
https://www.ncbi.nlm.nih.gov/pubmed/36933565
http://dx.doi.org/10.1016/S1473-3099(23)00118-4
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