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All Studies   All Outcomes    Recent:   
0 0.5 1 1.5 2+ Mortality 0% Improvement Relative Risk Ventilation 80% Severe case 0% Oxygen therapy 27% Time to viral- 1% Viral clearance -6% Time to viral-, ≤10 days 26% Paxlovid for COVID-19  Chen et al.  LATE TREATMENT Is late treatment with paxlovid beneficial for COVID-19? Retrospective 648 patients in China (April - June 2022) Lower ventilation with paxlovid (not stat. sig., p=0.22) c19early.org Chen et al., Immunity, Inflammation an.., Apr 2024 Favors paxlovid Favors control

Nirmatrelvir and ritonavir combination against COVID‐19 caused by omicron BA.2.2 in the elderly: A single‐center large observational study

Chen et al., Immunity, Inflammation and Disease, doi:10.1002/iid3.1232
Apr 2024  
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PSM retrospective 648 elderly COVID-19 patients showing no significant difference in time to viral clearance with paxlovid. However, in subgroup analysis of patients treated within 10 days of symptom onset, treatment was associated with faster viral clearance. There was no significant difference in mortality, progression to critical illness, or need for oxygen therapy.
Confounding by contraindication. Hoertel et al. find that over 50% of patients that died had a contraindication for the use of Paxlovid Hoertel. Retrospective studies that do not exclude contraindicated patients may significantly overestimate efficacy.
Black box warning. The FDA notes that "severe, life-threatening, and/or fatal adverse reactions due to drug interactions have been reported in patients treated with paxlovid" FDA.
risk of death, no change, RR 1.00, p = 1.00, treatment 10 of 324 (3.1%), control 10 of 324 (3.1%), propensity score matching.
risk of mechanical ventilation, 80.0% lower, RR 0.20, p = 0.22, treatment 1 of 324 (0.3%), control 5 of 324 (1.5%), NNT 81, propensity score matching.
risk of severe case, no change, RR 1.00, p = 1.00, treatment 6 of 324 (1.9%), control 6 of 324 (1.9%), propensity score matching.
risk of oxygen therapy, 27.3% lower, RR 0.73, p = 0.64, treatment 8 of 324 (2.5%), control 11 of 324 (3.4%), NNT 108, propensity score matching.
time to viral-, 1.0% lower, relative time 0.99, p = 0.91, treatment 324, control 324, adjusted per study, inverted to make RR<1 favor treatment, multivariable, Cox proportional hazards.
risk of no viral clearance, 5.6% higher, RR 1.06, p = 0.53, treatment 171 of 324 (52.8%), control 162 of 324 (50.0%), day 15.
time to viral-, 25.9% lower, relative time 0.74, p = 0.004, adjusted per study, inverted to make RR<1 favor treatment, ≤10 days, multivariable, Cox proportional hazards.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Chen et al., 5 Apr 2024, retrospective, China, peer-reviewed, median age 77.0, 8 authors, study period 26 April, 2022 - 30 June, 2022. Contact: chen.zhangzhang@zs-hospital.sh.cn, li.xiaoyu@zs-hospital.sh.cn.
This PaperPaxlovidAll
Nirmatrelvir and ritonavir combination against COVID‐19 caused by omicron BA.2.2 in the elderly: A single‐center large observational study
Can Chen, Ranyi Li, Shuliang Xing, Lei Cao, Yue Qu, Qianzhou Lv, Xiaoyu Li, Zhangzhang Chen
Immunity, Inflammation and Disease, doi:10.1002/iid3.1232
Background: Since coronavirus 2019 (COVID-19) swept the world, a variety of novel therapeutic and prevention strategies have been developed, among which nirmatrelvir-ritonavir is highly recommended. We intended to assess the effectiveness and safety of nirmatrelvir-ritonavir in the elderly mild-tomoderate COVID-19 population caused by the omicron BA.2.2 variant in realworld settings. Methods: An observational study was conducted retrospectively to review the outcomes of mild-to-moderate COVID-19 patients admitted between April 26 and June 30, 2022. Patients' baseline characteristics were collected and assessed. Participants in the intervention group were administered nirmatrelvir-ritonavir in addition to standard care, whereas those in the control group only received standard care. The primary outcome was the duration between the initial positive reverse-transcription polymerase chain reaction (RT-PCR) test and the subsequent conversion to a negative result. Results: The analysis included 324 patients who were administered nirmatrelvir-ritonavir and an equal number of control patients. The patient characteristics in both groups were evenly matched. The average duration from the initial positive RT-PCR to negative conversion was similar in both groups (16.2 ± 5.0 vs. 16.1 ± 6.3 days, p = .83). Control patients exhibited slower conversion in comparison to patients who received nirmatrelvir-ritonavir treatment within 10 days of symptom onset. Conclusions: These findings suggest that administering nirmatrelvirritonavir within 10 days of symptom onset could potentially reduce the time
AUTHOR CONTRIBUTIONS Can Chen: Investigation; methodology; writingoriginal draft; writing-review and editing. Ranyi Li: Data curation; formal analysis; software; writing-review and editing. Shuliang Xing: Project administration; resources; supervision. Lei Cao: Project administration; resources; supervision. Yue Qu: Methodology; writingreview and editing. Qianzhou Lv: Supervision. Xiaoyu Li: Conceptualization; data curation; funding acquisition; writing-review and editing. Zhangzhang Chen: Conceptualization; data curation; formal analysis; writing-review and editing. CONFLICT OF INTEREST STATEMENT The authors declare no conflicts of interest. ETHICS STATEMENT This study adhered to STROBE guidelines and received approval from the ethics committees of Zhongshan Hospital, Fudan University (approval number B2022-470R).
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Participants in the intervention group were ' 'administered nirmatrelvir–ritonavir in addition to standard care, whereas those in the ' 'control group only received standard care. The primary outcome was the duration between the ' 'initial positive reverse‐transcription polymerase chain reaction\xa0(RT‐PCR)\xa0test and the ' 'subsequent conversion to a negative ' 'result.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The analysis ' 'included 324 patients who were administered nirmatrelvir–ritonavir and an equal number of ' 'control patients. The patient characteristics in both groups were evenly matched. The average ' 'duration from the initial positive RT‐PCR to negative conversion was similar in both groups ' '(16.2\u2009±\u20095.0 vs. 16.1\u2009±\u20096.3 days, <jats:italic>p</jats:italic>\u2009=\u2009' '.83). 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Late treatment
is less effective
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