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Nirmatrelvir/ritonavir treatment and the risk of post-COVID condition over 180 days in Malaysia

Low et al., BMC Infectious Diseases, doi:10.1186/s12879-024-09679-1
Aug 2024  
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PASC, day 180 -30% Improvement Relative Risk PASC, day 90 29% Paxlovid  Low et al.  EARLY TREATMENT  LONG COVID Does paxlovid reduce the risk of long COVID (PASC)? Retrospective 2,524 patients in Malaysia (July 2022 - May 2023) Higher PASC with paxlovid (not stat. sig., p=0.34) c19early.org Low et al., BMC Infectious Diseases, Aug 2024 Favorspaxlovid Favorscontrol 0 0.5 1 1.5 2+
Retrospective 2,524 adult COVID-19 outpatients in Malaysia showing no significant difference in post-COVID condition (PCC) at 3 months and 6 months with paxlovid treatment.
Resistance. Variants may be resistant to paxlovid1-3. Use may promote the emergence of variants that weaken host immunity and potentially contribute to long COVID4.
Confounding by contraindication. Hoertel et al. find that over 50% of patients that died had a contraindication for the use of Paxlovid5. 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"6.
AKI. Kamo et al. show significantly increased risk of acute kidney injury.
risk of PASC, 30.0% higher, OR 1.30, p = 0.34, treatment 1,289, control 1,235, adjusted per study, multivariable, day 180, RR approximated with OR.
risk of PASC, 29.0% lower, OR 0.71, p = 0.43, treatment 1,289, control 1,235, adjusted per study, multivariable, day 90, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Low et al., 5 Aug 2024, retrospective, Malaysia, peer-reviewed, 11 authors, study period 14 July, 2022 - 14 May, 2023. Contact: evienlow@gmail.com, evlow@moh.gov.my.
This PaperPaxlovidAll
Nirmatrelvir/ritonavir treatment and the risk of post-COVID condition over 180 days in Malaysia
Ee Vien Low, Mohan Dass Pathmanathan, Yi Yang Ten, Suresh Kumar Chidambaram, Wee Ric Kim, Wei Jia Lee, Zhi Wei Teh, Maheshwara Rao Appannan, Mastura Ismail, Azah Abdul Samad, Kalaiarasu M Peariasamy
BMC Infectious Diseases, doi:10.1186/s12879-024-09679-1
Background The effect of nirmatrelvir/ritonavir on preventing post-COVID condition (PCC) in the BA4, BA5, and XBB Omicron predominant periods is not well understood. The purpose of this study was to assess how nirmatrelvir/ ritonavir treatment affected both PCC and health-related quality of life. Methods This retrospective cohort study enrolled 2,524 adults aged 18 years and older who were eligible for nirmatrelvir/ritonavir between July 14 to November 14, 2022. All outcomes were observed from the patient's first visit to the primary health clinic, 1 week, 1 month, 3 months, and 6 months after testing positive for COVID-19. The primary outcome was the presence of PCC. Secondary outcomes included the effects on health-related quality of life, such as walking, bathing and dressing, activities, cause adverse emotions or signs that prevent individuals from leading normal lives over a 180-day observation period. Results There were no significant differences observed between the nirmatrelvir/ritonavir and those not administered (control group) in terms of PCC symptoms at 3 months (OR 0.71 95% CI 0.31, 1.64) and 6 months (OR 1.30 95% CI 0.76, 2.21). At 3 months, the use of nirmatrelvir/ritonavir was associated with a 26% reduction in symptoms causing negative emotions (OR 0.74 95% CI 0.60, 0.92) and an increased likelihood of symptoms limiting walking (OR 1.58 95% CI 1.10, 2.27). However, there were no significant differences between the nirmatrelvir/ritonavir and the control group in terms of the impact of PCC on health-related quality of life at 6 months. Conclusions Our study indicates that the administration of nirmatrelvir/ritonavir does not significantly reduce PCC after 3 months and 6 months in a population with high vaccination coverage.
Supplementary Information The online version contains supplementary material available at https://doi. org/10.1186/s12879-024-09679-1. Supplementary Material 1 Supplementary Material 2 Author contributions EVL, MDP and KP designed the study. WRK, WJL, MR and ZWT collected the data. EVL and YYT acquired and analyzed the data. The data was interpreted by all authors. EVL wrote the first draft of the manuscript. All authors reviewed and edited the manuscript. EVL, MD, SC, MI, AAS and KP performed the critical revision of the manuscript for intellectual content. All authors had full access to all data in the studies and had final responsibility for the decision to submit for publication. Data availability The databases consist of individual-level information. The deidentified data that support the findings of this study are available upon reasonable request, and with protocol approved by the Medical Research and Ethics Committee, Ministry of Health Malaysia. Declarations Ethical approval This study was registered in the National Medical Research Register and approved by the Medical Research and Ethics Committee, Ministry of Health Malaysia (NMRR ID-22-00938-2YN). Data sharing statement The databases consist of individual-level information. The deidentified data that support the findings of this study are available upon reasonable request, and with protocol approved by the Medical Research and Ethics Committee, Ministry of Health Malaysia. Competing interests The authors..
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Post-COVID-19 Condition after SARS-CoV-2 ' 'infections during the Omicron Surge vs the Delta, Alpha, and wild type ' 'periods in Stockholm, Sweden. J Infect Dis. 2024;229(1):133–6.', 'journal-title': 'J Infect Dis'}, { 'issue': '2', 'key': '9679_CR35', 'doi-asserted-by': 'publisher', 'first-page': 'e12', 'DOI': '10.1016/S2213-2600(22)00501-X', 'volume': '11', 'author': 'C Saunders', 'year': '2023', 'unstructured': 'Saunders C, Sperling S, Bendstrup E. A new paradigm is needed to explain ' 'long COVID. Lancet Respiratory Med. 2023;11(2):e12–3.', 'journal-title': 'Lancet Respiratory Med'}, { 'issue': '7', 'key': '9679_CR36', 'doi-asserted-by': 'publisher', 'first-page': 'e28951', 'DOI': '10.1002/jmv.28951', 'volume': '95', 'author': 'TH Liu', 'year': '2023', 'unstructured': 'Liu TH, Wu JY, Huang PY, Tsai YW, Lai CC. The effect of ' 'nirmatrelvir-ritonavir on the long-term risk of neuropsychiatric ' 'sequelae following COVID-19. J Med Virol. 2023;95(7):e28951.', 'journal-title': 'J Med Virol'}], 'container-title': 'BMC Infectious Diseases', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://link.springer.com/content/pdf/10.1186/s12879-024-09679-1.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/article/10.1186/s12879-024-09679-1/fulltext.html', 'content-type': 'text/html', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/content/pdf/10.1186/s12879-024-09679-1.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2024, 8, 5]], 'date-time': '2024-08-05T06:03:53Z', 'timestamp': 1722837833000}, 'score': 1, 'resource': { 'primary': { 'URL': 'https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-09679-1'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2024, 8, 5]]}, 'references-count': 36, 'journal-issue': {'issue': '1', 'published-online': {'date-parts': [[2024, 12]]}}, 'alternative-id': ['9679'], 'URL': 'http://dx.doi.org/10.1186/s12879-024-09679-1', 'relation': {}, 'ISSN': ['1471-2334'], 'subject': [], 'container-title-short': 'BMC Infect Dis', 'published': {'date-parts': [[2024, 8, 5]]}, 'assertion': [ { 'value': '31 May 2024', 'order': 1, 'name': 'received', 'label': 'Received', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '29 July 2024', 'order': 2, 'name': 'accepted', 'label': 'Accepted', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '5 August 2024', 'order': 3, 'name': 'first_online', 'label': 'First Online', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, {'order': 1, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Declarations'}}, { 'value': 'This study was registered in the National Medical Research Register and ' 'approved by the Medical Research and Ethics Committee, Ministry of Health ' 'Malaysia (NMRR ID-22-00938-2YN).', 'order': 2, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Ethical approval'}}, { 'value': 'The databases consist of individual-level information. The deidentified data ' 'that support the findings of this study are available upon reasonable request, ' 'and with protocol approved by the Medical Research and Ethics Committee, ' 'Ministry of Health Malaysia.', 'order': 3, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Data sharing statement'}}, { 'value': 'The authors declare no competing interests.', 'order': 4, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Competing interests'}}, { 'value': 'The authors declare that they have no conflict of interests.', 'order': 5, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Conflict of interest'}}], 'article-number': '780'}
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