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0 0.5 1 1.5 2+ Time to viral- -10% Improvement Relative Risk Paxlovid for COVID-19  Guo et al.  LATE TREATMENT Is late treatment with paxlovid beneficial for COVID-19? Retrospective 1,978 patients in China (March - May 2022) Slower viral clearance with paxlovid (p=0.038) Guo et al., BMC Infectious Diseases, Oct 2023 Favors paxlovid Favors control

In-hospital adverse outcomes and risk factors among chronic kidney disease patients infected with the omicron variant of SARS-CoV-2: a single-center retrospective study

Guo et al., BMC Infectious Diseases, doi:10.1186/s12879-023-08620-2
Oct 2023  
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Retrospective 1,978 hospitalized patients in China, showing slower viral clearance with Paxlovid. Authors note improved results in the subgroup of non-severe patients with CKD.
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.
time to viral-, 10.0% higher, relative time 1.10, p = 0.04, treatment 779, control 1,199, median time of positive-to-negative conversion.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Guo et al., 18 Oct 2023, retrospective, China, peer-reviewed, median age 73.0, 18 authors, study period 29 March, 2022 - 17 May, 2022. Contact:,,,
This PaperPaxlovidAll
In-hospital adverse outcomes and risk factors among chronic kidney disease patients infected with the omicron variant of SARS-CoV-2: a single-center retrospective study
Yue Guo, Yifei Guo, Huajian Ying, Weien Yu, Shiqi Chen, Yao Zhang, Shenyan Zhang, Yanxue Lin, Feng Sun, Yongmei Zhang, Jie Yu, Ke Ma, Lunxiu Qin, Feng Long, Haoxiang Zhu, Richeng Mao, Jun Xue, Jiming Zhang
BMC Infectious Diseases, doi:10.1186/s12879-023-08620-2
Introduction The SARS-CoV-2 Omicron variant has decreased virulence and pathogenicity, yet the number of Omicron infections worldwide is unprecedentedly high, with rather high mortality and severe disease rate. Chronic kidney disease (CKD) patients are particularly vulnerable to the SARS-CoV-2 Omicron variant and have unique clinical outcomes. Methods We retrospectively collected data from 2140 hospitalized patients with SARS-CoV-2 Omicron variant infection from March 29, 2022, to May 17, 2022. Demographic characteristics, ancillary examination results, and clinical treatments were described. Occurrence of critical COVID-19 or death and time of positive-to-negative conversion was defined as primary outcomes. The presence of COVID-19 pneumonia and the usage of respiratory or circulatory support was defined as secondary outcomes. Univariate or multivariate logistic regression analyses were performed to identify risk factors for primary outcomes. Results 15.74% of CKD patients infected with the SARS-CoV-2 Omicron variant ended up with critical COVID-19 or death. Pre-existing CKD was a risk factor for critical COVID-19 or death and prolonged time of positive-to-negative conversion of SARS-CoV-2. Nirmatrelvir-ritonavir facilitated viral clearance among COVID-19 patients with non-severe CKD.
Abbreviations Supplementary Information The online version contains supplementary material available at https://doi. org/10.1186/s12879-023-08620-2. Supplementary Material 1 Authors' contributions Declarations Ethics approval and consent to participate Ethical approval was obtained from the Ethics Review Board of the Huashan Hospital, Fudan University (ethics approval registration number: KY2022-582). Informed consent forms were signed by each patient.All methods were carried out in accordance with relevant guidelines and regulations. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Late treatment
is less effective
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