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Comparative effectiveness of combination therapy with nirmatrelvir–ritonavir and remdesivir versus monotherapy with remdesivir or nirmatrelvir–ritonavir in patients hospitalised with COVID-19: a target trial emulation study

Choi et al., The Lancet Infectious Diseases, doi:10.1016/S1473-3099(24)00353-0
Jul 2024  
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Mortality -267% Improvement Relative Risk ICU admission -600% Ventilatory support -686% AKI -182% Remdesivir for COVID-19  Choi et al.  EARLY TREATMENT Is early treatment with remdesivir beneficial for COVID-19? Retrospective 13,964 patients in China (March - December 2022) Higher ICU admission (p<0.0001) and higher oxygen therapy (p<0.0001) c19early.org Choi et al., The Lancet Infectious Dis.., Jul 2024 Favorsremdesivir Favorscontrol 0 0.5 1 1.5 2+
Target trial emulation study of 18,196 hospitalized COVID-19 patients in Hong Kong showing significantly higher ICU admission and AKI with remdesivir + paxlovid compared with paxlovid alone, and lower mortality and ventilatory support with remdesivir + paxlovid compared with remdesivir alone. Patients were treated within 5 days of diagnosis, however the time from onset is not known.
Gérard, Zhou, Wu, Kamo, Choi, Kim show significantly increased risk of acute kidney injury with remdesivir.
Study covers remdesivir and paxlovid.
risk of death, 266.7% higher, HR 3.67, p = 0.07, treatment 308, control 13,656, remdesivir+paxlovid vs. paxlovid, day 90.
risk of ICU admission, 600.0% higher, HR 7.00, p < 0.001, treatment 308, control 13,656, remdesivir+paxlovid vs. paxlovid, day 90.
ventilatory support, 685.7% higher, HR 7.86, p < 0.001, treatment 308, control 13,656, remdesivir+paxlovid vs. paxlovid, day 90.
AKI, 181.6% higher, HR 2.82, p < 0.001, treatment 308, control 13,656, remdesivir+paxlovid vs. paxlovid, day 90.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Choi et al., 15 Jul 2024, retrospective, China, peer-reviewed, mean age 74.0, 8 authors, study period 16 March, 2022 - 31 December, 2022. Contact: ivanhung@hku.hk.
This PaperRemdesivirAll
Comparative effectiveness of combination therapy with nirmatrelvir–ritonavir and remdesivir versus monotherapy with remdesivir or nirmatrelvir–ritonavir in patients hospitalised with COVID-19: a target trial emulation study
Ming Hong Choi, Eric Yuk Fai Wan, Ian Chi Kei Wong, Esther Wai Yin Chan, Wing Ming Chu, Anthony Raymond Tam, Kwok Yung Yuen, Ivan Fan Ngai Hung
The Lancet Infectious Diseases, doi:10.1016/s1473-3099(24)00353-0
Background Remdesivir (Veklury, Gilead Sciences, Foster
References
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