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All Studies   All Outcomes    Recent:   

Association of nirmatrelvir/ritonavir treatment on upper respiratory SARS-CoV-2 RT-PCR negative conversion rates among high-risk patients with COVID-19

Li et al., Clinical Infectious Diseases, doi:10.1093/cid/ciac600
Jul 2022  
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0 0.5 1 1.5 2+ Viral clearance 79% Improvement Relative Risk Time to viral- 41% primary Viral clearance (b) 32% late Paxlovid for COVID-19  Li et al.  EARLY TREATMENT Is early treatment with paxlovid beneficial for COVID-19? Retrospective 399 patients in China (March - April 2022) Improved viral clearance with paxlovid (p<0.000001) c19early.org Li et al., Clinical Infectious Diseases, Jul 2022 Favors paxlovid Favors control
Retrospective 258 paxlovid patients and 224 patients before paxlovid was available in China, showing significantly faster viral clearance with treatment. Adjusted results are only provided for subgroups (≤5, >5 days from onset). Patients that discontinued treatment due to side effects were excluded. The treatment and control groups were separated in time. Control patients were hospitalized later, median 3 days [2-5] vs. 2 [1-3] for paxlovid patients.
Authors report some rebound events, but may not have monitored all patients for rebound. Authors report testing daily until negative conversion and it is unclear how many or when patients were tested after conversion.
Confounding by contraindication. Hoertel et al. find that over 50% of patients that died had a contraindication for the use of Paxlovid1. 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"2.
risk of no viral clearance, 79.4% lower, HR 0.21, p < 0.001, treatment 18 of 175 (10.3%), control 130 of 224 (58.0%), NNT 2.1, adjusted per study, inverted to make HR<1 favor treatment, model 2, multivariable, day 15.
time to viral-, 41.2% lower, relative time 0.59, p < 0.001, treatment median 10.0 IQR 5.0 n=175, control median 17.0 IQR 9.0 n=224, ≤5 days, primary outcome.
risk of no viral clearance, 32.0% lower, HR 0.68, p = 0.04, treatment 40 of 83 (48.2%), control 130 of 224 (58.0%), adjusted per study, inverted to make HR<1 favor treatment, >5 days, model 2, multivariable, day 15, late treatment result.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Li et al., 23 Jul 2022, retrospective, China, peer-reviewed, 20 authors, study period 5 March, 2022 - 5 April, 2022, average treatment delay 2.0 days. Contact: zhengyang@jlu.edu.cn.
This PaperPaxlovidAll
Association of nirmatrelvir/ritonavir treatment on upper respiratory SARS-CoV-2 RT-PCR negative conversion rates among high-risk patients with COVID-19
PhD Hongyan Li, PhD Menghan Gao, MD Hailong You, MD Peng Zhang, MM Yuchen Pan, MD Nan Li, MD Ling Qin, MD Heyuan Wang, MD Dan Li, MD Yang Li, MD Hongmei Qiao, MD Lina Gu, MD Songbai Xu, MD Weiying Guo, MD Nanya Wang, MD Chaoying Liu, MD Pujun Gao, MD Junqi Niu, MD Jie Cao, MD Yang Zheng, Prof H Li
doi:10.1093/cid/ciac600/6649232
Background: Acceleration of negative respiratory conversion of SARS-CoV-2 in patients with coronavirus disease 2019 (COVID-19) might reduce viral transmission. Nirmatrelvir/ritonavir is a new antiviral agent recently approved for treatment of COVID-19 that has the potential to facilitate negative conversion. Methods: A cohort of hospitalized adult patients with mild-to-moderate COVID-19 who had a high-risk for progression to severe disease were studied. These patients presented with COVID-19 symptoms between March 5 and April 5, 2022. The time from positive to negative upper respiratory RT-PCR conversion was assessed by Kaplan-Meier plots and Cox proportional hazards regression with the adjustment for patients baseline demographic and clinical characteristics. Results: There were 258 patients treated with nirmatrelvir/ritonavir and 224 nontreated patients who had mild-to-moderate COVID-19. The median (interquartile range) time for patients who converted from positive to negative RT-PCR was 10 Conclusion: This cohort study of high-risk patients with mild-to-moderate COVID-19 found an association between nirmatrelvir/ritonavir treatment and accelerated negative RT-PCR respiratory SARS-CoV-2 conversion that might reduce the risk of viral shedding and disease transmission.
Conflict of Interest Disclosures: None reported. Funding/Support: None.
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' 'Nirmatrelvir/ritonavir is a new antiviral agent recently approved for treatment of COVID-19 ' 'that has the potential to facilitate negative conversion.</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Methods</jats:title>\n' ' <jats:p>A cohort of hospitalized adult patients with mild-to-moderate ' 'COVID-19 who had a high-risk for progression to severe disease were studied. These patients ' 'presented with COVID-19 symptoms between March 5 and April 5, 2022. The time from positive to ' 'negative upper respiratory RT-PCR conversion was assessed by Kaplan-Meier plots and Cox ' 'proportional hazards regression with the adjustment for patients baseline demographic and ' 'clinical characteristics.</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Results</jats:title>\n' ' <jats:p>There were 258 patients treated with nirmatrelvir/ritonavir and 224 ' 'non-treated patients who had mild-to-moderate COVID-19. 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'1537-6591'], 'subject': ['Infectious Diseases', 'Microbiology (medical)'], 'published': {'date-parts': [[2022, 7, 23]]}}
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