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0 0.5 1 1.5 2+ Mortality 5% Improvement Relative Risk Paxlovid for COVID-19  Park et al.  EARLY TREATMENT Is early treatment with paxlovid beneficial for COVID-19? Retrospective 2,507 patients in South Korea (Jan - Aug 2022) No significant difference in mortality c19early.org Park et al., Research Square, June 2023 Favors paxlovid Favors control

The association of mortality with vaccination and underlying disease among COVID-19 patients in long term care hospitals at Daegu and Gyeonsangbuk-do in Korea

Park et al., Research Square, doi:10.21203/rs.3.rs-3003449/v1
Jun 2023  
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Retrospective 2,507 COVID-19 patients at 18 long term care hospitals with COVID-19 outbreaks in Korea, showing no significant difference in mortality with paxlovid treatment. Note that this study is less affected by the typical confounding in paxlovid population studies since the standard of care and treatment propensity for additional treatments is likely to be more similar for this population. Treatment delay is unknown and authors note that treatment may have been delayed.
In most population studies patients receiving paxlovid may have more contact with the medical system, be more likely to follow other recommendations, be more likely to receive additional care, and be more likely to take additional treatments that are not tracked in the data (e.g., nasal/oral hygiene c19early.org, c19early.org (B), vitamin D c19early.org (C), etc.).
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 death, 5.0% lower, RR 0.95, p = 0.86, treatment 940, control 1,567, adjusted per study, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Park et al., 16 Jun 2023, retrospective, South Korea, peer-reviewed, 11 authors, study period January 2022 - August 2022.
This PaperPaxlovidAll
The association of mortality with vaccination and underlying disease among COVID-19 patients in long term care hospitals at Daegu and Gyeonsangbuk-do in Korea
Hanul Park, Chungmin Park, Seong-Ju Choi, Yeon Haw Jung, Myung-Jae Hwang, Junseock Son, Inyeong Seo, Taeyeon Park, You Kyung Kim, Ji-Seon Seong, Taejong Son
doi:10.21203/rs.3.rs-3003449/v1
Background This study aimed to estimate the effects of vaccine on reducing the mortality rate and the relationship between underlying diseases and death among long term care hospital residents during the Omicron epidemic. Methods This study included 2,507 inpatients at 18 long term care hospitals that experienced COVID-19 outbreaks more than twice in Daegu Metropolitan City and Gyeongsangbuk-do in Korea, from January 2022 to August 2022. Descriptive statistics were used to analyze participants' demographic characteristics and mortality, which were expressed as percentages (%). Logistic regression analysis was performed to compare mortality, and the crude risk ratio (cRR) and adjusted risk risk (aRR) were estimated. The analysis model was adjusted for sex, age, region, history of Paxlovid priscription, vaccine status, reinfection, and presence, type, and number of underlying diseases. Results In terms of vaccination status, the aRR in the group with < 90 days after the 3 doses was 0.20 (CI:0.09-0.45) and ≥ 90 days was 0.14 (CI:0.06-0.32), that in the group with < 90 days after 4 doses was 0.18 (CI:0.06-0.43), compared with the non-vaccinated group. The fatality rate in the group prescribed Paxlovid was higher than that in the non-prescribed group. However, the difference was not statistically signi cant. The aRR of hypothyroidism was 5.75 (CI:1.10-30.13) and that of COPD and asthma were 2.84 (CI:1.15-6.99), compared with the group that did not have each underlying disease. Conclusion We con rmed the preventive effects of vaccination on death and the high risk of death from hypothyroidism, COPD, and asthma in COVID-19-con rmed patients in long term care hospitals.
Abbreviations
References
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The analysis model was adjusted for sex, age, ' 'region, history of Paxlovid priscription, vaccine status, reinfection, and presence, type, ' 'and number of underlying diseases.\n' 'Results\n' ' In terms of vaccination status, the aRR in the group with &lt;\u200990 days after the 3 ' 'doses was 0.20 (CI:0.09–0.45) and ≥\u200990 days was 0.14 (CI:0.06–0.32), that in the group ' 'with &lt;\u200990 days after 4 doses was 0.18 (CI:0.06–0.43), compared with the ' 'non-vaccinated group. The fatality rate in the group prescribed Paxlovid was higher than that ' 'in the non-prescribed group. However, the difference was not statistically significant. 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