Conv. Plasma
Nigella Sativa

All paxlovid studies
Meta analysis
study COVID-19 treatment researchPaxlovidPaxlovid (more..)
Melatonin Meta
Azvudine Meta Metformin Meta
Bromhexine Meta
Budesonide Meta Molnupiravir Meta
Colchicine Meta
Conv. Plasma Meta
Curcumin Meta Nigella Sativa Meta
Famotidine Meta Nitazoxanide Meta
Favipiravir Meta Paxlovid Meta
Fluvoxamine Meta Quercetin Meta
Hydroxychlor.. Meta Remdesivir Meta
Ivermectin Meta
Lactoferrin Meta

All Studies   All Outcomes   Recent:  
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) Li et al., Clinical Infectious Diseases, Jul 2022 Favors paxlovid Favors control

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  
  Source   PDF   All Studies   Meta AnalysisMeta
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 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 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.
All Studies   All Outcomes   Submit Updates or Corrections
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
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.
Anand, Ziebuhr, Wadhwani, Mesters, Hilgenfeld, Coronavirus main proteinase (3CLpro) structure: basis for design of anti-SARS drugs, Science
Barnett, Mehrotra, Landon, Covid-19 and the upcoming financial crisis in health care, NEJM Catalyst Innovations in Care Delivery
Borio, Bright, Emanuel, A National Strategy for COVID-19 Medical Countermeasures: Vaccines and Therapeutics, JAMA
Cevik, Kuppalli, Kindrachuk, Peiris, Virology, transmission, and pathogenesis of SARS-CoV-2
Charness, Gupta, Stack, Rapid Relapse of Symptomatic Omicron SARS-CoV-2 Infection Following Early Suppression with Nirmatrelvir/Ritonavir
Chowdhury, Luhar, Khan, Choudhury, Matin et al., Longterm strategies to control COVID-19 in low and middle-income countries: an options overview of community-based, non-pharmacological interventions, European journal of epidemiology
Docherty, Harrison, Green, Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study
Drew, Donnell, Leblanc, Mcmahon, Natin, The importance of cycle threshold values in interpreting molecular tests for SARS-CoV-2, Diagnostic microbiology and infectious disease
Gandhi, Malani, Rio, COVID-19 Therapeutics for Nonhospitalized Patients, JAMA
Gottlieb, Vaca, Paredes, Early remdesivir to prevent progression to severe Covid-19 in outpatients, New England Journal of Medicine
Hammond, Leister-Tebbe, Gardner, Oral nirmatrelvir for highrisk, nonhospitalized adults with COVID-19, New England Journal of Medicine
Hammond, Leister-Tebbe, Gardner, Oral nirmatrelvir for highrisk, nonhospitalized adults with COVID-19, New England Journal of Medicine
Harrison, Lin, Wang, Mechanisms of SARS-CoV-2 transmission and pathogenesis, Trends in immunology
He, Zeng, Xiao, When and How to Adjust Non-Pharmacological Interventions Concurrent with Booster Vaccinations Against COVID-19-Guangdong, China, 2022, China CDC Weekly
Kim, Garg, 'halloran, Risk factors for intensive care unit admission and in-hospital mortality among hospitalized adults identified through the US coronavirus disease 2019 (COVID-19)-associated hospitalization surveillance network (COVID-NET), Clinical Infectious Diseases
Kotecha, Light, Checcucci, Repurposing of drugs for Covid-19: a systematic review and meta-analysis, MedRxiv
Lamb, Nirmatrelvir Plus Ritonavir: First Approval, Drugs
Li, Wang, Lavrijsen, SARS-CoV-2 Omicron variant is highly sensitive to molnupiravir, nirmatrelvir, and the combination, Cell Research
Lim, Hor, Tay, Efficacy of Ivermectin treatment on disease progression among adults with mild to moderate COVID-19 and comorbidities: the I-TECH randomized clinical trial, JAMA Internal Medicine
Owen, Allerton, Anderson, An oral SARS-CoV-2 Mpro inhibitor clinical candidate for the treatment of COVID-19, Science
Ranganath, Horo, Challener, Rebound Phenomenon after Nirmatrelvir/Ritonavir Treatment of Coronavirus Disease-2019 in High-Risk Persons, Clinical Infectious Diseases
Rao, Manissero, Steele, Pareja, A systematic review of the clinical utility of cycle threshold values in the context of COVID-19, Infectious diseases and therapy
Rhee, Kanjilal, Baker, Klompas, Duration of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infectivity: when is it safe to discontinue isolation?, Clinical infectious diseases
Sevrioukova, Poulos, Structure and mechanism of the complex between cytochrome P4503A4 and ritonavir, Proceedings of the National Academy of Sciences
Singh, Toussi, Hackman, Innovative Randomized Phase 1 Study and Dosing Regimen Selection to Accelerate and Inform Pivotal COVID-19 Trial of Nirmatrelvir, Clinical Pharmacology & Therapeutics
Thakur, Dubey, Benitez, A systematic review and meta-analysis of geographic differences in comorbidities and associated severity and mortality among individuals with COVID-19, Scientific reports
Ullrich, Ekanayake, Otting, Nitsche, Main protease mutants of SARS-CoV-2 variants remain susceptible to nirmatrelvir, Bioorganic & Medicinal Chemistry Letters
Van Kampen, De Vijver, Fraaij, Duration and key determinants of infectious virus shedding in hospitalized patients with coronavirus disease-2019 (COVID-19), Nature communications
Vangeel, Chiu, Jonghe, Molnupiravir and Nirmatrelvir remain active against SARS-CoV-2 Omicron and other variants of concern, Antiviral Research
Verna, Alallon, Murakami, Analytical Performance of COVID-19 Detection Methods (RT-PCR): Scientific and Societal Concerns, Life
Wu, Mcgoogan, Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention, jama
Yu, Cai, Deng, Projecting the impact of the introduction of SARS-CoV-2 Omicron variant in China in the context of waning immunity after vaccination
Zhang, Liang, Tang, Negative Conversion Rate of SARS-CoV-2
Please send us corrections, updates, or comments. c19early involves the extraction of over 100,000 datapoints from thousands of papers. Community updates help ensure high accuracy. Vaccines and treatments are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment, vaccine, or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
  or use drag and drop