Outcomes in COVID-19 paxlovid studies
Outcomes in paxlovid studies. Pfizer has denied access to Paxlovid for independent RCTs
Ledford . Pfizer RCTs report very good results, while non-Pfizer RCTs show relatively poor results
Liu , Yu . Variants may be resistant to paxlovid
Jochmans , Lopez , Zhou .
Hoertel find that >50% of patients that died had a contraindication for paxlovid. 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 . Use may promote the emergence of variants that weaken host immunity and potentially contribute to long COVID
Thomas . Population studies often do not account for the different expected outcomes for the class of patients that seek out and receive early treatment.
Kamo show significantly increased risk of acute kidney injury.
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1.5+ All studies 16% 74 164,085 Improvement, Studies, Patients Relative Risk Mortality 25% 38 108,232 Ventilation -12% 11 14,518 ICU admission 0% 13 43,625 Hospitalization 38% 20 74,154 Progression 2% 16 44,170 Recovery 7% 12 4,663 Cases 36% 1 1,670 Viral clearance 14% 24 10,558 RCTs 11% 7 5,937 RCT mortality 44% 4 3,774 Peer-reviewed 14% 57 130,690 Prophylaxis 67% 1 1,670 Early 19% 54 113,629 Late -2% 20 49,185 Paxlovid for COVID-19 c19 earlyDecember 2024 after exclusions Favors paxlovid Favors control
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2+ EPIC-HR Hammond (DB RCT) 96% 0.04 [0.00-0.68] death 0/1,039 12/1,046 Improvement, RR [CI] Treatment Control Wong (PSM) 66% 0.34 [0.23-0.50] death 890 (n) 890 (n) Yip (PSW) 19% 0.81 [0.47-1.39] death/ICU Arbel 56% 0.44 [0.08-2.59] death population-based cohort Najjar-Debbiny 46% 0.54 [0.39-0.75] severe case population-based cohort EPIC-SR Pfizer (DB RCT) 67% 0.33 [0.01-8.08] death 0/654 1/634 Shao 20% 0.80 [0.71-0.91] viral time 17 (n) 114 (n) OT1 Li (ES) 79% 0.21 [0.15-0.28] viral+ 18/175 130/224 Lu 12% 0.88 [0.78-0.98] viral+ n/a n/a Ganatra (PSM) 95% 0.05 [0.00-0.81] death 0/1,130 10/1,130 confounding Shao 20% 0.80 [0.71-0.91] viral time 17 (n) 114 (n) OT1 Zhong 15% 0.85 [0.65-1.13] recov. time 106 (n) 36 (n) Zhou (PSM) 73% 0.27 [0.13-0.58] death 7/2,808 100/10,849 Wong (PSM) 66% 0.34 [0.22-0.52] death Schwartz (PSW) 50% 0.50 [0.41-0.61] death population-based cohort Pandit 1% 0.99 [0.83-1.17] no recov. n/a n/a Bajema (PSM) 58% 0.42 [0.26-0.67] death 20/1,587 48.6/1,587 Dryden-Peterson 71% 0.29 [0.12-0.71] death confounding Cai 9% 0.91 [0.51-1.62] death 18/61 14/43 Zheng (PSW) -4% 1.04 [0.56-1.93] death/hosp. 4,836 (n) 2,847 (n) OT1 Evans 41% 0.59 [0.36-0.97] death/hosp. 602 (n) 4,973 (n) Shah 51% 0.49 [0.46-0.53] hosp. population-based cohort confounding Liu (RCT) 38% 0.62 [0.21-1.86] death 5/132 8/132 Lewnard -40% 1.40 [0.73-2.66] death population-based cohort confounding Yan 31% 0.69 [0.30-1.58] death 7/73 17/122 Patel (PSM) 20% 0.80 [0.67-0.95] PASC 1,004 (n) 1,004 (n) Li -51% 1.51 [1.11-2.05] recov. time 9 (n) 11 (n) Park 5% 0.95 [0.57-1.62] death 940 (n) 1,567 (n) Wee 14% 0.86 [0.48-1.55] severe case population-based cohort Yang 2% 0.98 [0.95-1.00] death 220 (n) 1,061 (n) POSITIVES Edelstein -761% 8.61 [1.13-34.2] rebound 15/72 1/55 Kim 31% 0.69 [0.63-0.75] death population-based cohort Dormuth 29% 0.71 [0.54-0.93] death/hosp. 85/3,433 120/3,433 confounding Lin -633% 7.33 [0.86-62.7] oxygen 4/30 1/55 Dalton (PSM) 8% 0.92 [0.91-0.93] PASC n/a n/a Fung 7% 0.93 [0.92-0.94] PASC population-based cohort LONG COVID Low (PSM) 0% 1.00 [0.06-16.0] death 1/10,483 1/10,483 Ioannou (PSM) 1% 0.99 [0.95-1.03] PASC 9,593 (n) 9,593 (n) LONG COVID Xu 12% 0.88 [0.76-1.02] hosp. time 195 (n) 120 (n) Durstenfeld (PSW) -14% 1.14 [0.83-1.54] PASC 57/353 176/1,258 LONG COVID Choi 37% 0.63 [0.46-0.86] death 251 (n) 1,592 (n) Preiss 2% 0.98 [0.95-1.01] PASC population-based cohort LONG COVID Zhu -79% 1.79 [1.39-2.33] viral+ 138 (n) 155 (n) Cheng 22% 0.78 [0.60-1.00] death 2,083 (n) 2,045 (n) Wang 13% 0.87 [0.46-1.63] death 66 (n) 55 (n) Henderson 84% 0.16 [0.05-0.50] hosp. confounding Yang 0% 1.00 [0.84-1.18] viral+ 362 (n) 724 (n) RECOVERY Horby (RCT) -1% 1.01 [0.43-2.40] death 9/68 9/69 Choi 34% 0.66 [0.49-0.89] death 308 (n) 4,232 (n) Low -30% 1.30 [0.76-2.21] PASC 1,289 (n) 1,235 (n) LONG COVID Yen 31% 0.69 [0.37-1.30] death 220 (n) 1,976 (n) Deng (PSM) -17% 1.17 [0.54-2.53] viral time 9 (n) 9 (n) Yu 9% 0.91 [0.17-4.93] death 130 (all patients) Mikhail 0% 1.00 [0.40-2.41] progression 1,166 (n) 1,607 (n) Tau2 = 0.01, I2 = 92.5%, p < 0.0001 Early treatment 19% 0.81 [0.77-0.85] 246/46,419 648.6/67,080 19% lower risk Li 32% 0.68 [0.47-0.98] viral+ 40/83 130/224 Improvement, RR [CI] Treatment Control Wan 28% 0.72 [0.62-0.84] death 541/6,604 2,541/17,283 Wan 23% 0.77 [0.66-0.90] death 1,813 (n) 5,306 (n) Shao 29% 0.71 [0.44-1.14] death 280 (n) 802 (n) Fu -280% 3.80 [0.41-35.4] ventilation 3/49 1/62 OT1 Shao 29% 0.71 [0.44-1.14] death 280 (n) 509 (n) Yu (RCT) -2% 1.02 [0.21-4.93] severe case 3/103 3/105 OT1 Dian (PSM) -175% 2.75 [0.89-8.51] death 11/228 4/228 OT1 Li 18% 0.82 [0.47-1.43] death 14/73 35/150 Zhou -39% 1.39 [1.02-1.89] death 52/132 54/190 Wei 0% 1.00 [0.68-1.46] death 36/264 63/461 OT1 Guo -10% 1.10 [1.01-1.20] viral time 779 (n) 1,199 (n) Lu -6% 1.06 [0.77-1.47] death 17/29 140/253 Liu -94% 1.94 [1.24-3.03] progression 27/145 41/427 Peng -79% 1.79 [0.43-7.42] death 21 (n) 145 (n) Chen (PSM) 0% 1.00 [0.42-2.37] death 10/324 10/324 Liu (PSM) -272% 3.72 [1.02-13.6] progression 148 (all patients) Lv -495% 5.95 [2.72-13.0] death 35/148 7/176 Lai 20% 0.80 [0.68-0.95] death 5,165 (n) 4,388 (n) Pfizer (DB RCT) 8% 0.92 [0.72-1.18] no recov. 186 (n) 99 (n) Tau2 = 0.07, I2 = 82.6%, p = 0.81 Late treatment -2% 1.02 [0.87-1.20] 789/16,706 3,029/32,331 2% higher risk EPIC-PEP Pfizer (DB RCT) 67% 0.33 [0.01-8.20] hosp. 0/830 1/840 Improvement, RR [CI] Treatment Control Tau2 = 0.00, I2 = 0.0%, p = 0.51 Prophylaxis 67% 0.33 [0.01-8.20] 0/830 1/840 67% lower risk All studies 16% 0.84 [0.81-0.88] 1,035/63,955 3,678.6/100,251 16% lower risk 74 paxlovid COVID-19 studies c19 earlyDecember 2024 Tau2 = 0.01, I2 = 90.6%, p < 0.0001 Effect extraction pre-specified (most serious outcome) 1 OT: comparison with other treatment Favors paxlovid Favors control
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2+ EPIC-HR Hammond (DB RCT) 96% 0.04 [0.00-0.68] death 0/1,039 12/1,046 Improvement, RR [CI] Treatment Control Wong (PSM) 66% 0.34 [0.23-0.50] death 890 (n) 890 (n) Yip (PSW) 19% 0.81 [0.47-1.39] death/ICU Arbel 56% 0.44 [0.08-2.59] death population-based cohort Najjar-Debbiny 46% 0.54 [0.39-0.75] severe case population-based cohort EPIC-SR Pfizer (DB RCT) 67% 0.33 [0.01-8.08] death 0/654 1/634 Li (ES) 79% 0.21 [0.15-0.28] viral+ 18/175 130/224 Lu 12% 0.88 [0.78-0.98] viral+ n/a n/a Zhong 15% 0.85 [0.65-1.13] recov. time 106 (n) 36 (n) Zhou (PSM) 73% 0.27 [0.13-0.58] death 7/2,808 100/10,849 Wong (PSM) 66% 0.34 [0.22-0.52] death Schwartz (PSW) 50% 0.50 [0.41-0.61] death population-based cohort Pandit 1% 0.99 [0.83-1.17] no recov. n/a n/a Bajema (PSM) 58% 0.42 [0.26-0.67] death 20/1,587 48.6/1,587 Cai 9% 0.91 [0.51-1.62] death 18/61 14/43 Zheng (PSW) -4% 1.04 [0.56-1.93] death/hosp. 4,836 (n) 2,847 (n) OT1 Evans 41% 0.59 [0.36-0.97] death/hosp. 602 (n) 4,973 (n) Liu (RCT) 38% 0.62 [0.21-1.86] death 5/132 8/132 Yan 31% 0.69 [0.30-1.58] death 7/73 17/122 Patel (PSM) 20% 0.80 [0.67-0.95] PASC 1,004 (n) 1,004 (n) Li -51% 1.51 [1.11-2.05] recov. time 9 (n) 11 (n) Park 5% 0.95 [0.57-1.62] death 940 (n) 1,567 (n) Wee 14% 0.86 [0.48-1.55] severe case population-based cohort Yang 2% 0.98 [0.95-1.00] death 220 (n) 1,061 (n) POSITIVES Edelstein -761% 8.61 [1.13-34.2] rebound 15/72 1/55 Kim 31% 0.69 [0.63-0.75] death population-based cohort Lin -633% 7.33 [0.86-62.7] oxygen 4/30 1/55 Dalton (PSM) 8% 0.92 [0.91-0.93] PASC n/a n/a Fung 7% 0.93 [0.92-0.94] PASC population-based cohort LONG COVID Low (PSM) 0% 1.00 [0.06-16.0] death 1/10,483 1/10,483 Ioannou (PSM) 1% 0.99 [0.95-1.03] PASC 9,593 (n) 9,593 (n) LONG COVID Xu 12% 0.88 [0.76-1.02] hosp. time 195 (n) 120 (n) Durstenfeld (PSW) -14% 1.14 [0.83-1.54] PASC 57/353 176/1,258 LONG COVID Choi 37% 0.63 [0.46-0.86] death 251 (n) 1,592 (n) Preiss 2% 0.98 [0.95-1.01] PASC population-based cohort LONG COVID Zhu -79% 1.79 [1.39-2.33] viral+ 138 (n) 155 (n) Cheng 22% 0.78 [0.60-1.00] death 2,083 (n) 2,045 (n) Wang 13% 0.87 [0.46-1.63] death 66 (n) 55 (n) Yang 0% 1.00 [0.84-1.18] viral+ 362 (n) 724 (n) RECOVERY Horby (RCT) -1% 1.01 [0.43-2.40] death 9/68 9/69 Choi 34% 0.66 [0.49-0.89] death 308 (n) 4,232 (n) Low -30% 1.30 [0.76-2.21] PASC 1,289 (n) 1,235 (n) LONG COVID Yen 31% 0.69 [0.37-1.30] death 220 (n) 1,976 (n) Deng (PSM) -17% 1.17 [0.54-2.53] viral time 9 (n) 9 (n) Yu 9% 0.91 [0.17-4.93] death 130 (all patients) Mikhail 0% 1.00 [0.40-2.41] progression 1,166 (n) 1,607 (n) Tau2 = 0.01, I2 = 87.4%, p < 0.0001 Early treatment 14% 0.86 [0.82-0.89] 161/41,822 518.6/62,289 14% lower risk Li 32% 0.68 [0.47-0.98] viral+ 40/83 130/224 Improvement, RR [CI] Treatment Control Wan 28% 0.72 [0.62-0.84] death 541/6,604 2,541/17,283 Wan 23% 0.77 [0.66-0.90] death 1,813 (n) 5,306 (n) Shao 29% 0.71 [0.44-1.14] death 280 (n) 802 (n) Shao 29% 0.71 [0.44-1.14] death 280 (n) 509 (n) Yu (RCT) -2% 1.02 [0.21-4.93] severe case 3/103 3/105 OT1 Dian (PSM) -175% 2.75 [0.89-8.51] death 11/228 4/228 OT1 Wei 0% 1.00 [0.68-1.46] death 36/264 63/461 OT1 Guo -10% 1.10 [1.01-1.20] viral time 779 (n) 1,199 (n) Lu -6% 1.06 [0.77-1.47] death 17/29 140/253 Liu -94% 1.94 [1.24-3.03] progression 27/145 41/427 Chen (PSM) 0% 1.00 [0.42-2.37] death 10/324 10/324 Liu (PSM) -272% 3.72 [1.02-13.6] progression 148 (all patients) Lai 20% 0.80 [0.68-0.95] death 5,165 (n) 4,388 (n) Pfizer (DB RCT) 8% 0.92 [0.72-1.18] no recov. 186 (n) 99 (n) Tau2 = 0.05, I2 = 81.4%, p = 0.31 Late treatment 8% 0.92 [0.79-1.08] 685/16,283 2,932/31,608 8% lower risk EPIC-PEP Pfizer (DB RCT) 67% 0.33 [0.01-8.20] hosp. 0/830 1/840 Improvement, RR [CI] Treatment Control Tau2 = 0.00, I2 = 0.0%, p = 0.51 Prophylaxis 67% 0.33 [0.01-8.20] 0/830 1/840 67% lower risk All studies 13% 0.87 [0.84-0.90] 846/58,935 3,451.6/94,737 13% lower risk 61 paxlovid COVID-19 studies after exclusions c19 earlyDecember 2024 Tau2 = 0.01, I2 = 84.9%, p < 0.0001 Effect extraction pre-specified (most serious outcome) 1 OT: comparison with other treatment Favors paxlovid Favors control
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2+ EPIC-HR Hammond (DB RCT) 96% 0.04 [0.00-0.68] 0/1,039 12/1,046 Improvement, RR [CI] Treatment Control Wong (PSM) 66% 0.34 [0.23-0.50] 890 (n) 890 (n) Arbel 56% 0.44 [0.08-2.59] population-based cohort EPIC-SR Pfizer (DB RCT) 67% 0.33 [0.01-8.08] 0/654 1/634 Ganatra (PSM) 95% 0.05 [0.00-0.81] 0/1,130 10/1,130 confounding Zhou (PSM) 73% 0.27 [0.13-0.58] 7/2,808 100/10,849 Wong (PSM) 66% 0.34 [0.22-0.52] Schwartz (PSW) 50% 0.50 [0.41-0.61] population-based cohort Bajema (PSM) 58% 0.42 [0.26-0.67] 20/1,587 48.6/1,587 Dryden-Peterson 71% 0.29 [0.12-0.71] confounding Cai 9% 0.91 [0.51-1.62] 18/61 14/43 Liu (RCT) 38% 0.62 [0.21-1.86] 5/132 8/132 Lewnard -40% 1.40 [0.73-2.66] population-based cohort confounding Yan 31% 0.69 [0.30-1.58] 7/73 17/122 Park 5% 0.95 [0.57-1.62] 940 (n) 1,567 (n) Yang 2% 0.98 [0.95-1.00] 220 (n) 1,061 (n) Kim 31% 0.69 [0.63-0.75] population-based cohort Low (PSM) 0% 1.00 [0.06-16.0] 1/10,483 1/10,483 Choi 37% 0.63 [0.46-0.86] 251 (n) 1,592 (n) Cheng 22% 0.78 [0.60-1.00] 2,083 (n) 2,045 (n) Wang 13% 0.87 [0.46-1.63] 66 (n) 55 (n) RECOVERY Horby (RCT) -1% 1.01 [0.43-2.40] 9/68 9/69 Choi 34% 0.66 [0.49-0.89] 308 (n) 4,232 (n) Yen 31% 0.69 [0.37-1.30] 220 (n) 1,976 (n) Yu 9% 0.91 [0.17-4.93] 130 (all patients) Tau2 = 0.11, I2 = 89.7%, p < 0.0001 Early treatment 38% 0.62 [0.51-0.74] 67/23,013 220.6/39,513 38% lower risk Wan 28% 0.72 [0.62-0.84] 541/6,604 2,541/17,283 Improvement, RR [CI] Treatment Control Wan 23% 0.77 [0.66-0.90] 1,813 (n) 5,306 (n) Shao 29% 0.71 [0.44-1.14] 280 (n) 802 (n) Shao 29% 0.71 [0.44-1.14] 280 (n) 509 (n) Dian (PSM) -175% 2.75 [0.89-8.51] 11/228 4/228 OT1 Li 18% 0.82 [0.47-1.43] 14/73 35/150 Zhou -39% 1.39 [1.02-1.89] 52/132 54/190 Wei 0% 1.00 [0.68-1.46] 36/264 63/461 OT1 Lu -6% 1.06 [0.77-1.47] 17/29 140/253 Peng -79% 1.79 [0.43-7.42] 21 (n) 145 (n) Chen (PSM) 0% 1.00 [0.42-2.37] 10/324 10/324 Lv -495% 5.95 [2.72-13.0] 35/148 7/176 Lai 20% 0.80 [0.68-0.95] 5,165 (n) 4,388 (n) Tau2 = 0.07, I2 = 77.7%, p = 0.81 Late treatment 2% 0.98 [0.81-1.18] 716/15,361 2,854/30,215 2% lower risk All studies 25% 0.75 [0.66-0.85] 783/38,374 3,074.6/69,728 25% lower risk 38 paxlovid COVID-19 mortality results c19 earlyDecember 2024 Tau2 = 0.08, I2 = 88.1%, p < 0.0001 1 OT: comparison with other treatment Favors paxlovid Favors control
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2+ Wong (PSM) 3% 0.97 [0.31-3.03] 890 (n) 890 (n) Improvement, RR [CI] Treatment Control Wong (PSM) 38% 0.62 [0.23-1.72] Bajema (PSM) 48% 0.52 [0.12-2.16] 3/1,587 5.8/1,587 Cai 30% 0.70 [0.29-1.73] 8/61 8/43 Liu (RCT) -67% 1.67 [0.62-4.45] 10/132 6/132 RECOVERY Horby (RCT) -1% 1.01 [0.06-15.9] 1/68 1/69 Tau2 = 0.00, I2 = 0.0%, p = 0.53 Early treatment 14% 0.86 [0.54-1.36] 22/2,738 20.8/2,721 14% lower risk Wan -3% 1.03 [0.70-1.52] 1,813 (n) 5,306 (n) Improvement, RR [CI] Treatment Control Fu -280% 3.80 [0.41-35.4] 3/49 1/62 OT1 Dian (PSM) -200% 3.00 [0.61-14.7] 6/228 2/228 OT1 Wei -38% 1.38 [1.02-1.87] 61/264 77/461 OT1 Chen (PSM) 80% 0.20 [0.02-1.70] 1/324 5/324 Tau2 = 0.06, I2 = 36.8%, p = 0.29 Late treatment -24% 1.24 [0.83-1.85] 71/2,678 85/6,381 24% higher risk All studies -12% 1.12 [0.87-1.44] 93/5,416 105.8/9,102 12% higher risk 11 paxlovid COVID-19 mechanical ventilation results c19 earlyDecember 2024 Tau2 = 0.02, I2 = 11.1%, p = 0.4 1 OT: comparison with other treatment Favors paxlovid Favors control
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2+ Wong (PSM) -58% 1.58 [0.95-2.63] Improvement, RR [CI] Treatment Control Bajema (PSM) 56% 0.44 [0.21-0.92] 10/1,587 22.8/1,587 Cai 11% 0.89 [0.64-1.22] 34/61 27/43 Liu (RCT) -10% 1.10 [0.56-2.12] 132 (n) 132 (n) Yan 14% 0.86 [0.52-1.43] 17/73 33/122 Low (PSM) 67% 0.33 [0.01-8.18] 0/10,483 1/10,483 Choi -40% 1.40 [0.16-12.6] 251 (n) 1,592 (n) Cheng 14% 0.86 [0.56-1.32] 2,083 (n) 2,045 (n) Choi 37% 0.63 [0.28-1.38] 308 (n) 4,232 (n) Tau2 = 0.02, I2 = 19.9%, p = 0.36 Early treatment 10% 0.90 [0.72-1.13] 61/14,978 83.8/20,236 10% lower risk Wan -8% 1.08 [0.58-2.02] 1,813 (n) 5,306 (n) Improvement, RR [CI] Treatment Control Fu -659% 7.59 [0.95-61.0] 6/49 1/62 OT1 Dian (PSM) 0% 1.00 [0.06-15.9] 1/228 1/228 OT1 Wei -122% 2.22 [0.98-5.03] 14/264 11/461 OT1 Tau2 = 0.15, I2 = 32.6%, p = 0.12 Late treatment -70% 1.70 [0.87-3.32] 21/2,354 13/6,057 70% higher risk All studies 0% 1.00 [0.78-1.27] 82/17,332 96.8/26,293 0% lower risk 13 paxlovid COVID-19 ICU results c19 earlyDecember 2024 Tau2 = 0.06, I2 = 36.0%, p = 0.98 1 OT: comparison with other treatment Favors paxlovid Favors control
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2+ EPIC-HR Hammond (DB RCT) 88% 0.12 [0.06-0.26] hosp. 8/1,039 65/1,046 Improvement, RR [CI] Treatment Control Wong (PSM) 4% 0.96 [0.88-1.04] hosp. time 890 (n) 890 (n) Yip (PSW) 21% 0.79 [0.65-0.95] hosp. Arbel 57% 0.43 [0.16-1.17] hosp. population-based cohort EPIC-SR Pfizer (DB RCT) 52% 0.48 [0.17-1.41] hosp. 5/654 10/634 Ganatra (PSM) 56% 0.44 [0.21-0.91] hosp. 10/1,130 23/1,130 confounding Zhou (PSM) 84% 0.16 [0.11-0.22] hosp. 34/2,808 752/10,849 Wong (PSM) 24% 0.76 [0.67-0.86] hosp. Bajema (PSM) 7% 0.93 [0.74-1.16] hosp. 180/1,587 194.2/1,587 Dryden-Peterson 40% 0.60 [0.44-0.81] hosp. confounding Cai 20% 0.80 [0.67-0.96] hosp. time 61 (n) 43 (n) Shah 51% 0.49 [0.46-0.53] hosp. population-based cohort confounding Yan 9% 0.91 [0.84-0.99] hosp. time 73 (n) 122 (n) Wee 35% 0.65 [0.50-0.85] hosp. population-based cohort Low (PSM) 36% 0.64 [0.43-0.94] hosp. 42/10,483 67/10,483 Xu 12% 0.88 [0.76-1.02] hosp. time 195 (n) 120 (n) Henderson 84% 0.16 [0.05-0.50] hosp. confounding Mikhail 33% 0.67 [0.40-1.14] hosp. 1,166 (n) 1,607 (n) Tau2 = 0.12, I2 = 94.6%, p < 0.0001 Early treatment 40% 0.60 [0.49-0.72] 279/20,086 1,111.2/28,511 40% lower risk Wan 24% 0.76 [0.70-0.82] hosp. 1,772/6,604 2,541/17,283 Improvement, RR [CI] Treatment Control Tau2 = 0.00, I2 = 0.0%, p < 0.0001 Late treatment 24% 0.76 [0.70-0.82] 1,772/6,604 2,541/17,283 24% lower risk EPIC-PEP Pfizer (DB RCT) 67% 0.33 [0.01-8.20] hosp. 0/830 1/840 Improvement, RR [CI] Treatment Control Tau2 = 0.00, I2 = 0.0%, p = 0.51 Prophylaxis 67% 0.33 [0.01-8.20] 0/830 1/840 67% lower risk All studies 38% 0.62 [0.53-0.72] 2,051/27,520 3,653.2/46,634 38% lower risk 20 paxlovid COVID-19 hospitalization results c19 earlyDecember 2024 Tau2 = 0.09, I2 = 94.1%, p < 0.0001 Favors paxlovid Favors control
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2+ EPIC-HR Hammond (DB RCT) 96% 0.04 [0.00-0.68] death 0/1,039 12/1,046 Improvement, RR [CI] Treatment Control Wong (PSM) 66% 0.34 [0.23-0.50] death 890 (n) 890 (n) Yip (PSW) 19% 0.81 [0.47-1.39] death/ICU Arbel 56% 0.44 [0.08-2.59] death population-based cohort Najjar-Debbiny 46% 0.54 [0.39-0.75] severe case population-based cohort EPIC-SR Pfizer (DB RCT) 67% 0.33 [0.01-8.08] death 0/654 1/634 Ganatra (PSM) 95% 0.05 [0.00-0.81] death 0/1,130 10/1,130 confounding Zhou (PSM) 73% 0.27 [0.13-0.58] death 7/2,808 100/10,849 Wong (PSM) 66% 0.34 [0.22-0.52] death Schwartz (PSW) 50% 0.50 [0.41-0.61] death population-based cohort Bajema (PSM) 58% 0.42 [0.26-0.67] death 20/1,587 48.6/1,587 Dryden-Peterson 71% 0.29 [0.12-0.71] death confounding Cai 9% 0.91 [0.51-1.62] death 18/61 14/43 Zheng (PSW) -4% 1.04 [0.56-1.93] death/hosp. 4,836 (n) 2,847 (n) OT1 Evans 41% 0.59 [0.36-0.97] death/hosp. 602 (n) 4,973 (n) Shah 51% 0.49 [0.46-0.53] hosp. population-based cohort confounding Liu (RCT) 38% 0.62 [0.21-1.86] death 5/132 8/132 Lewnard -40% 1.40 [0.73-2.66] death population-based cohort confounding Yan 31% 0.69 [0.30-1.58] death 7/73 17/122 Patel (PSM) 20% 0.80 [0.67-0.95] PASC 1,004 (n) 1,004 (n) Park 5% 0.95 [0.57-1.62] death 940 (n) 1,567 (n) Wee 14% 0.86 [0.48-1.55] severe case population-based cohort Yang 2% 0.98 [0.95-1.00] death 220 (n) 1,061 (n) Kim 31% 0.69 [0.63-0.75] death population-based cohort Dormuth 29% 0.71 [0.54-0.93] death/hosp. 85/3,433 120/3,433 confounding Lin -633% 7.33 [0.86-62.7] oxygen 4/30 1/55 Dalton (PSM) 8% 0.92 [0.91-0.93] PASC n/a n/a Fung 7% 0.93 [0.92-0.94] PASC population-based cohort LONG COVID Low (PSM) 0% 1.00 [0.06-16.0] death 1/10,483 1/10,483 Ioannou (PSM) 1% 0.99 [0.95-1.03] PASC 9,593 (n) 9,593 (n) LONG COVID Durstenfeld (PSW) -14% 1.14 [0.83-1.54] PASC 57/353 176/1,258 LONG COVID Choi 37% 0.63 [0.46-0.86] death 251 (n) 1,592 (n) Preiss 2% 0.98 [0.95-1.01] PASC population-based cohort LONG COVID Cheng 22% 0.78 [0.60-1.00] death 2,083 (n) 2,045 (n) Wang 13% 0.87 [0.46-1.63] death 66 (n) 55 (n) Henderson 84% 0.16 [0.05-0.50] hosp. confounding RECOVERY Horby (RCT) -1% 1.01 [0.43-2.40] death 9/68 9/69 Choi 34% 0.66 [0.49-0.89] death 308 (n) 4,232 (n) Low -30% 1.30 [0.76-2.21] PASC 1,289 (n) 1,235 (n) LONG COVID Yen 31% 0.69 [0.37-1.30] death 220 (n) 1,976 (n) Yu 9% 0.91 [0.17-4.93] death 130 (all patients) Mikhail 0% 1.00 [0.40-2.41] progression 1,166 (n) 1,607 (n) Tau2 = 0.01, I2 = 93.3%, p < 0.0001 Early treatment 24% 0.76 [0.72-0.81] 213/45,319 517.6/65,518 24% lower risk Wan 28% 0.72 [0.62-0.84] death 541/6,604 2,541/17,283 Improvement, RR [CI] Treatment Control Wan 23% 0.77 [0.66-0.90] death 1,813 (n) 5,306 (n) Shao 29% 0.71 [0.44-1.14] death 280 (n) 802 (n) Fu -280% 3.80 [0.41-35.4] ventilation 3/49 1/62 OT1 Shao 29% 0.71 [0.44-1.14] death 280 (n) 509 (n) Yu (RCT) -2% 1.02 [0.21-4.93] severe case 3/103 3/105 OT1 Dian (PSM) -175% 2.75 [0.89-8.51] death 11/228 4/228 OT1 Li 18% 0.82 [0.47-1.43] death 14/73 35/150 Zhou -39% 1.39 [1.02-1.89] death 52/132 54/190 Wei 0% 1.00 [0.68-1.46] death 36/264 63/461 OT1 Lu -6% 1.06 [0.77-1.47] death 17/29 140/253 Liu -94% 1.94 [1.24-3.03] progression 27/145 41/427 Peng -79% 1.79 [0.43-7.42] death 21 (n) 145 (n) Chen (PSM) 0% 1.00 [0.42-2.37] death 10/324 10/324 Liu (PSM) -272% 3.72 [1.02-13.6] progression 148 (all patients) Lv -495% 5.95 [2.72-13.0] death 35/148 7/176 Lai 20% 0.80 [0.68-0.95] death 5,165 (n) 4,388 (n) Tau2 = 0.09, I2 = 78.9%, p = 0.45 Late treatment -8% 1.08 [0.89-1.32] 749/15,658 2,899/30,809 8% higher risk EPIC-PEP Pfizer (DB RCT) 67% 0.33 [0.01-8.20] hosp. 0/830 1/840 Improvement, RR [CI] Treatment Control Tau2 = 0.00, I2 = 0.0%, p = 0.51 Prophylaxis 67% 0.33 [0.01-8.20] 0/830 1/840 67% lower risk All studies 20% 0.80 [0.76-0.84] 962/61,807 3,417.6/97,167 20% lower risk 60 paxlovid COVID-19 serious outcomes c19 earlyDecember 2024 Tau2 = 0.01, I2 = 91.6%, p < 0.0001 Effect extraction pre-specified (most serious outcome) 1 OT: comparison with other treatment Favors paxlovid Favors control
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+ EPIC-HR Hammond (DB RCT) 17% 0.83 [0.74-0.93] no recov. 686 (n) 674 (n) Improvement, RR [CI] Treatment Control EPIC-SR Pfizer (DB RCT) 8% 0.92 [0.82-1.03] recov. time 654 (n) 634 (n) Zhong 15% 0.85 [0.65-1.13] recov. time 106 (n) 36 (n) Pandit 1% 0.99 [0.83-1.17] no recov. n/a n/a Li -51% 1.51 [1.11-2.05] recov. time 9 (n) 11 (n) Lin 35% 0.65 [0.43-0.98] recov. time 30 (n) 55 (n) Xu 35% 0.65 [0.57-0.74] recov. time 195 (n) 120 (n) RECOVERY Horby (RCT) -35% 1.35 [0.76-2.42] no disch. 20/68 15/69 Yu 34% 0.66 [0.45-0.99] no recov. 130 (all patients) Tau2 = 0.04, I2 = 80.6%, p = 0.098 Early treatment 12% 0.88 [0.75-1.02] 20/1,748 15/1,599 12% lower risk Shao -28% 1.28 [1.13-1.45] HRQoL 237 (n) 456 (n) Improvement, RR [CI] Treatment Control Yu (RCT) -6% 1.06 [0.79-1.43] no disch. 49/103 47/105 OT1 Pfizer (DB RCT) 8% 0.92 [0.72-1.18] no recov. 186 (n) 99 (n) Tau2 = 0.02, I2 = 67.4%, p = 0.38 Late treatment -10% 1.10 [0.89-1.37] 49/526 47/660 10% higher risk All studies 7% 0.93 [0.80-1.08] 69/2,274 62/2,259 7% lower risk 12 paxlovid COVID-19 recovery results c19 earlyDecember 2024 Tau2 = 0.05, I2 = 85.9%, p = 0.37 1 OT: comparison with other treatment Favors paxlovid Favors control
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+ EPIC-PEP Pfizer (DB RCT) 36% 0.65 [0.37-1.11] symp. case 830 (n) 840 (n) Improvement, RR [CI] Treatment Control Tau2 = 0.00, I2 = 0.0%, p = 0.12 Prophylaxis 36% 0.65 [0.37-1.11] 830 (n) 840 (n) 36% lower risk All studies 36% 0.65 [0.37-1.11] 830 (n) 840 (n) 36% lower risk 1 paxlovid COVID-19 case result c19 earlyDecember 2024 Tau2 = 0.00, I2 = 0.0%, p = 0.12 Favors paxlovid Favors control
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+ EPIC-HR Hammond (DB RCT) 12% 0.88 [0.83-0.93] viral load 529 (n) 526 (n) Improvement, RR [CI] Treatment Control Wong (PSM) 28% 0.72 [0.56-0.93] viral+ 890 (n) 890 (n) EPIC-SR Pfizer (DB RCT) 4% 0.96 [0.92-1.00] viral load 654 (n) 634 (n) Shao 20% 0.80 [0.71-0.91] viral time 17 (n) 114 (n) OT1 Li (ES) 79% 0.21 [0.15-0.28] viral+ 18/175 130/224 Lu 12% 0.88 [0.78-0.98] viral+ n/a n/a Shao 20% 0.80 [0.71-0.91] viral time 17 (n) 114 (n) OT1 Zhong 16% 0.84 [0.74-0.96] viral time 106 (n) 36 (n) Pandit 3% 0.97 [0.83-1.14] viral+ n/a n/a Cai 47% 0.53 [0.36-0.77] viral+ 61 (n) 43 (n) Liu (RCT) 5% 0.95 [0.85-1.07] viral time 132 (n) 132 (n) Yan 62% 0.38 [0.22-0.68] viral time 73 (n) 122 (n) Li 58% 0.42 [0.19-0.93] viral time 9 (n) 11 (n) POSITIVES Edelstein -761% 8.61 [1.13-34.2] rebound 15/72 1/55 Xu 58% 0.42 [0.33-0.54] viral time 195 (n) 120 (n) Zhu -79% 1.79 [1.39-2.33] viral+ 138 (n) 155 (n) Yang 0% 1.00 [0.84-1.18] viral+ 362 (n) 724 (n) RECOVERY Horby (RCT) 19% 0.81 [0.76-0.86] viral load 68 (n) 69 (n) Deng (PSM) -17% 1.17 [0.54-2.53] viral time 9 (n) 9 (n) Tau2 = 0.03, I2 = 88.9%, p < 0.0001 Early treatment 19% 0.81 [0.74-0.89] 33/3,507 131/3,978 19% lower risk Li 32% 0.68 [0.47-0.98] viral+ 40/83 130/224 Improvement, RR [CI] Treatment Control Yu (RCT) 12% 0.88 [0.66-1.18] viral+ 30/103 34/105 OT1 Guo -10% 1.10 [1.01-1.20] viral time 779 (n) 1,199 (n) Chen 1% 0.99 [0.84-1.16] viral time 324 (n) 324 (n) Pfizer (DB RCT) 18% 0.82 [0.73-0.91] viral load 218 (n) 113 (n) Tau2 = 0.03, I2 = 83.6%, p = 0.23 Late treatment 10% 0.90 [0.75-1.07] 70/1,507 164/1,965 10% lower risk All studies 14% 0.86 [0.80-0.93] 103/5,014 295/5,943 14% lower risk 24 paxlovid COVID-19 viral clearance results c19 earlyDecember 2024 Tau2 = 0.02, I2 = 85.4%, p < 0.0001 1 OT: comparison with other treatment Favors paxlovid Favors control
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+ EPIC-HR Hammond (DB RCT) 96% 0.04 [0.00-0.68] death 0/1,039 12/1,046 Improvement, RR [CI] Treatment Control EPIC-SR Pfizer (DB RCT) 67% 0.33 [0.01-8.08] death 0/654 1/634 Liu (RCT) 38% 0.62 [0.21-1.86] death 5/132 8/132 RECOVERY Horby (RCT) -1% 1.01 [0.43-2.40] death 9/68 9/69 Tau2 = 0.37, I2 = 38.8%, p = 0.24 Early treatment 44% 0.56 [0.21-1.48] 14/1,893 30/1,881 44% lower risk Yu (RCT) -2% 1.02 [0.21-4.93] severe case 3/103 3/105 OT1 Improvement, RR [CI] Treatment Control Pfizer (DB RCT) 8% 0.92 [0.72-1.18] no recov. 186 (n) 99 (n) Tau2 = 0.00, I2 = 0.0%, p = 0.53 Late treatment 8% 0.92 [0.72-1.18] 3/289 3/204 8% lower risk EPIC-PEP Pfizer (DB RCT) 67% 0.33 [0.01-8.20] hosp. 0/830 1/840 Improvement, RR [CI] Treatment Control Tau2 = 0.00, I2 = 0.0%, p = 0.51 Prophylaxis 67% 0.33 [0.01-8.20] 0/830 1/840 67% lower risk All studies 11% 0.89 [0.71-1.11] 17/3,012 34/2,925 11% lower risk 7 paxlovid COVID-19 Randomized Controlled Trials c19 earlyDecember 2024 Tau2 = 0.00, I2 = 0.0%, p = 0.3 Effect extraction pre-specified (most serious outcome) 1 OT: comparison with other treatment Favors paxlovid Favors control
0
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0.75
1
1.25
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2+ EPIC-HR Hammond (DB RCT) 96% 0.04 [0.00-0.68] 0/1,039 12/1,046 Improvement, RR [CI] Treatment Control EPIC-SR Pfizer (DB RCT) 67% 0.33 [0.01-8.08] 0/654 1/634 Liu (RCT) 38% 0.62 [0.21-1.86] 5/132 8/132 RECOVERY Horby (RCT) -1% 1.01 [0.43-2.40] 9/68 9/69 Tau2 = 0.37, I2 = 38.8%, p = 0.24 Early treatment 44% 0.56 [0.21-1.48] 14/1,893 30/1,881 44% lower risk All studies 44% 0.56 [0.21-1.48] 14/1,893 30/1,881 44% lower risk 4 paxlovid COVID-19 RCT mortality results c19 earlyDecember 2024 Tau2 = 0.37, I2 = 38.8%, p = 0.24 Favors paxlovid Favors control
0
0.25
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0.75
1
1.25
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1.75
2+ EPIC-HR Hammond (DB RCT) 96% 0.04 [0.00-0.68] death 0/1,039 12/1,046 Improvement, RR [CI] Treatment Control Wong (PSM) 66% 0.34 [0.23-0.50] death 890 (n) 890 (n) Yip (PSW) 19% 0.81 [0.47-1.39] death/ICU Arbel 56% 0.44 [0.08-2.59] death population-based cohort Najjar-Debbiny 46% 0.54 [0.39-0.75] severe case population-based cohort Li (ES) 79% 0.21 [0.15-0.28] viral+ 18/175 130/224 Lu 12% 0.88 [0.78-0.98] viral+ n/a n/a Ganatra (PSM) 95% 0.05 [0.00-0.81] death 0/1,130 10/1,130 confounding Shao 20% 0.80 [0.71-0.91] viral time 17 (n) 114 (n) OT1 Zhong 15% 0.85 [0.65-1.13] recov. time 106 (n) 36 (n) Wong (PSM) 66% 0.34 [0.22-0.52] death Dryden-Peterson 71% 0.29 [0.12-0.71] death confounding Cai 9% 0.91 [0.51-1.62] death 18/61 14/43 Evans 41% 0.59 [0.36-0.97] death/hosp. 602 (n) 4,973 (n) Shah 51% 0.49 [0.46-0.53] hosp. population-based cohort confounding Liu (RCT) 38% 0.62 [0.21-1.86] death 5/132 8/132 Lewnard -40% 1.40 [0.73-2.66] death population-based cohort confounding Yan 31% 0.69 [0.30-1.58] death 7/73 17/122 Li -51% 1.51 [1.11-2.05] recov. time 9 (n) 11 (n) Park 5% 0.95 [0.57-1.62] death 940 (n) 1,567 (n) Wee 14% 0.86 [0.48-1.55] severe case population-based cohort Kim 31% 0.69 [0.63-0.75] death population-based cohort Dormuth 29% 0.71 [0.54-0.93] death/hosp. 85/3,433 120/3,433 confounding Lin -633% 7.33 [0.86-62.7] oxygen 4/30 1/55 Fung 7% 0.93 [0.92-0.94] PASC population-based cohort LONG COVID Low (PSM) 0% 1.00 [0.06-16.0] death 1/10,483 1/10,483 Ioannou (PSM) 1% 0.99 [0.95-1.03] PASC 9,593 (n) 9,593 (n) LONG COVID Xu 12% 0.88 [0.76-1.02] hosp. time 195 (n) 120 (n) Durstenfeld (PSW) -14% 1.14 [0.83-1.54] PASC 57/353 176/1,258 LONG COVID Zhu -79% 1.79 [1.39-2.33] viral+ 138 (n) 155 (n) Cheng 22% 0.78 [0.60-1.00] death 2,083 (n) 2,045 (n) Wang 13% 0.87 [0.46-1.63] death 66 (n) 55 (n) Henderson 84% 0.16 [0.05-0.50] hosp. confounding Yang 0% 1.00 [0.84-1.18] viral+ 362 (n) 724 (n) Choi 34% 0.66 [0.49-0.89] death 308 (n) 4,232 (n) Low -30% 1.30 [0.76-2.21] PASC 1,289 (n) 1,235 (n) LONG COVID Yen 31% 0.69 [0.37-1.30] death 220 (n) 1,976 (n) Deng (PSM) -17% 1.17 [0.54-2.53] viral time 9 (n) 9 (n) Yu 9% 0.91 [0.17-4.93] death 130 (all patients) Mikhail 0% 1.00 [0.40-2.41] progression 1,166 (n) 1,607 (n) Tau2 = 0.06, I2 = 93.0%, p < 0.0001 Early treatment 23% 0.77 [0.70-0.85] 195/34,902 489/47,268 23% lower risk Li 32% 0.68 [0.47-0.98] viral+ 40/83 130/224 Improvement, RR [CI] Treatment Control Wan 28% 0.72 [0.62-0.84] death 541/6,604 2,541/17,283 Wan 23% 0.77 [0.66-0.90] death 1,813 (n) 5,306 (n) Shao 29% 0.71 [0.44-1.14] death 280 (n) 802 (n) Shao 29% 0.71 [0.44-1.14] death 280 (n) 509 (n) Yu (RCT) -2% 1.02 [0.21-4.93] severe case 3/103 3/105 OT1 Dian (PSM) -175% 2.75 [0.89-8.51] death 11/228 4/228 OT1 Li 18% 0.82 [0.47-1.43] death 14/73 35/150 Zhou -39% 1.39 [1.02-1.89] death 52/132 54/190 Wei 0% 1.00 [0.68-1.46] death 36/264 63/461 OT1 Guo -10% 1.10 [1.01-1.20] viral time 779 (n) 1,199 (n) Lu -6% 1.06 [0.77-1.47] death 17/29 140/253 Liu -94% 1.94 [1.24-3.03] progression 27/145 41/427 Peng -79% 1.79 [0.43-7.42] death 21 (n) 145 (n) Chen (PSM) 0% 1.00 [0.42-2.37] death 10/324 10/324 Liu (PSM) -272% 3.72 [1.02-13.6] progression 148 (all patients) Lv -495% 5.95 [2.72-13.0] death 35/148 7/176 Lai 20% 0.80 [0.68-0.95] death 5,165 (n) 4,388 (n) Tau2 = 0.08, I2 = 84.2%, p = 0.78 Late treatment -3% 1.03 [0.87-1.22] 786/16,471 3,028/32,170 3% higher risk All studies 14% 0.86 [0.79-0.93] 981/51,373 3,517/79,438 14% lower risk 57 paxlovid COVID-19 peer reviewed studies c19 earlyDecember 2024 Tau2 = 0.05, I2 = 91.0%, p = 0.00027 Effect extraction pre-specified (most serious outcome) 1 OT: comparison with other treatment Favors paxlovid Favors control
0
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2+ EPIC-HR Hammond (DB RCT) 96% 0.04 [0.00-0.68] death 0/1,039 12/1,046 Improvement, RR [CI] Treatment Control EPIC-HR Hammond (DB RCT) 95% 0.05 [0.00-0.89] death 0/697 9/682 EPIC-HR Hammond (DB RCT) 88% 0.12 [0.06-0.26] hosp. 8/1,039 65/1,046 EPIC-HR Hammond (DB RCT) 89% 0.11 [0.04-0.28] hosp. 5/697 44/682 EPIC-HR Hammond (DB RCT) -11% 1.11 [0.85-1.44] progression 686 (n) 674 (n) EPIC-HR Hammond (DB RCT) 17% 0.83 [0.74-0.93] no recov. 686 (n) 674 (n) EPIC-HR Hammond (DB RCT) 21% 0.79 [0.71-0.89] no recov. 686 (n) 674 (n) EPIC-HR Hammond (DB RCT) 12% 0.88 [0.83-0.93] viral load 529 (n) 526 (n) EPIC-HR Hammond (DB RCT) 5% 0.95 [0.90-1.00] viral load 529 (n) 526 (n) Wong (PSM) 66% 0.34 [0.23-0.50] death 890 (n) 890 (n) Wong (PSM) 3% 0.97 [0.31-3.03] ventilation 890 (n) 890 (n) Wong (PSM) 43% 0.57 [0.45-0.72] progression 890 (n) 890 (n) Wong (PSM) 4% 0.96 [0.88-1.04] hosp. time 890 (n) 890 (n) Wong (PSM) 28% 0.72 [0.56-0.93] viral+ 890 (n) 890 (n) Yip (PSW) 19% 0.81 [0.47-1.39] death/ICU Yip (PSW) 21% 0.79 [0.65-0.95] hosp. Arbel 56% 0.44 [0.08-2.59] death population-based cohort Arbel 79% 0.21 [0.05-0.82] death Arbel -32% 1.32 [0.16-10.8] death Arbel 57% 0.43 [0.16-1.17] hosp. population-based cohort Arbel 73% 0.27 [0.15-0.49] hosp. Arbel 26% 0.74 [0.35-1.58] hosp. Najjar-Debbiny 46% 0.54 [0.39-0.75] severe case population-based cohort EPIC-SR Pfizer (DB RCT) 67% 0.33 [0.01-8.08] death 0/654 1/634 EPIC-SR Pfizer (DB RCT) 52% 0.48 [0.17-1.41] hosp. 5/654 10/634 EPIC-SR Pfizer (DB RCT) 4% 0.96 [0.91-1.02] progression 494/654 498/634 EPIC-SR Pfizer (DB RCT) 8% 0.92 [0.82-1.03] recov. time 654 (n) 634 (n) EPIC-SR Pfizer (DB RCT) 4% 0.96 [0.92-1.00] viral load 654 (n) 634 (n) Shao 20% 0.80 [0.71-0.91] viral time 17 (n) 114 (n) OT1 Li (ES) 79% 0.21 [0.15-0.28] viral+ 18/175 130/224 Li (ES) 41% 0.59 [0.50-0.69] viral time 175 (n) 224 (n) Lu 12% 0.88 [0.78-0.98] viral+ n/a n/a Ganatra (PSM) 95% 0.05 [0.00-0.81] death 0/1,130 10/1,130 confounding Ganatra (PSM) 39% 0.61 [0.42-0.70] progression 89/1,130 163/1,130 confounding Ganatra (PSM) 33% 0.67 [0.52-0.87] progression 89/1,130 163/1,130 confounding Ganatra (PSM) 56% 0.44 [0.21-0.91] hosp. 10/1,130 23/1,130 confounding Shao 20% 0.80 [0.71-0.91] viral time 17 (n) 114 (n) OT1 Zhong 15% 0.85 [0.65-1.13] recov. time 106 (n) 36 (n) Zhong 16% 0.84 [0.74-0.96] viral time 106 (n) 36 (n) Zhong 16% 0.84 [0.76-0.93] viral time 106 (n) 36 (n) Zhou (PSM) 73% 0.27 [0.13-0.58] death 7/2,808 100/10,849 Zhou (PSM) 75% 0.25 [0.10-0.61] death 5/2,808 78/10,849 Zhou (PSM) 84% 0.16 [0.11-0.22] hosp. 34/2,808 752/10,849 Zhou (PSM) 89% 0.11 [0.07-0.17] hosp. 22/2,808 708/10,849 Wong (PSM) 66% 0.34 [0.22-0.52] death Wong (PSM) 38% 0.62 [0.23-1.72] ventilation Wong (PSM) -58% 1.58 [0.95-2.63] ICU Wong (PSM) 24% 0.76 [0.67-0.86] hosp. Schwartz (PSW) 50% 0.50 [0.41-0.61] death population-based cohort Schwartz (PSW) 43% 0.57 [0.48-0.68] death/hosp. population-based cohort Pandit 1% 0.99 [0.83-1.17] no recov. n/a n/a Pandit 3% 0.97 [0.83-1.14] viral+ n/a n/a Pandit -171% 2.71 [0.86-8.55] misc. 24/127 3/43 Pandit -52% 1.52 [0.55-4.25] misc. 18/127 4/43 Bajema (PSM) 58% 0.42 [0.26-0.67] death 20/1,587 48.6/1,587 Bajema (PSM) 79% 0.21 [0.08-0.56] death 5/1,587 23.6/1,587 Bajema (PSM) 48% 0.52 [0.12-2.16] ventilation 3/1,587 5.8/1,587 Bajema (PSM) 56% 0.44 [0.21-0.92] ICU 10/1,587 22.8/1,587 Bajema (PSM) 7% 0.93 [0.74-1.16] hosp. 180/1,587 194.2/1,587 Bajema (PSM) 34% 0.66 [0.45-0.96] hosp. 43/1,587 65.2/1,587 Dryden-Peterson 71% 0.29 [0.12-0.71] death confounding Dryden-Peterson 44% 0.56 [0.42-0.75] death/hosp. confounding Dryden-Peterson 40% 0.60 [0.44-0.81] hosp. confounding Cai 9% 0.91 [0.51-1.62] death 18/61 14/43 Cai 30% 0.70 [0.29-1.73] ventilation 8/61 8/43 Cai 11% 0.89 [0.64-1.22] ICU 34/61 27/43 Cai 3% 0.97 [0.62-1.53] ICU 61 (n) 43 (n) Cai 20% 0.80 [0.67-0.96] hosp. time 61 (n) 43 (n) Cai 47% 0.53 [0.36-0.77] viral+ 61 (n) 43 (n) Zheng (PSW) -4% 1.04 [0.56-1.93] death/hosp. 4,836 (n) 2,847 (n) OT1 Zheng (PSW) 12% 0.88 [0.45-1.71] death/hosp. 33/4,836 19/2,847 OT1 Evans 41% 0.59 [0.36-0.97] death/hosp. 602 (n) 4,973 (n) Shah 51% 0.49 [0.46-0.53] hosp. population-based cohort confounding Liu (RCT) 38% 0.62 [0.21-1.86] death 5/132 8/132 Liu (RCT) -67% 1.67 [0.62-4.45] ventilation 10/132 6/132 Liu (RCT) -10% 1.10 [0.56-2.12] ICU 132 (n) 132 (n) Liu (RCT) -27% 1.27 [0.67-2.38] progression 19/132 15/132 Liu (RCT) 5% 0.95 [0.85-1.07] viral time 132 (n) 132 (n) Lewnard -40% 1.40 [0.73-2.66] death population-based cohort confounding Lewnard 84% 0.16 [0.03-0.81] death/ICU n/a n/a confounding Lewnard 89% 0.11 [0.01-1.25] death/ICU n/a n/a confounding Lewnard 54% 0.46 [0.23-0.93] death/hosp. n/a n/a confounding Lewnard 80% 0.20 [0.06-0.66] death/hosp. n/a n/a confounding Yan 31% 0.69 [0.30-1.58] death 7/73 17/122 Yan 44% 0.56 [0.32-0.96] progression 73 (n) 122 (n) Yan 14% 0.86 [0.52-1.43] ICU 17/73 33/122 Yan 9% 0.91 [0.84-0.99] hosp. time 73 (n) 122 (n) Yan 62% 0.38 [0.22-0.68] viral time 73 (n) 122 (n) Yan 73% 0.27 [0.19-0.38] viral+ 73 (n) 122 (n) Patel (PSM) 20% 0.80 [0.67-0.95] PASC 1,004 (n) 1,004 (n) Patel (PSM) 25% 0.75 [0.62-0.90] PASC 1,004 (n) 1,004 (n) Patel (PSM) 29% 0.71 [0.58-0.85] PASC 1,004 (n) 1,004 (n) Patel (PSM) 26% 0.74 [0.60-0.90] PASC 1,004 (n) 1,004 (n) Li -51% 1.51 [1.11-2.05] recov. time 9 (n) 11 (n) Li 58% 0.42 [0.19-0.93] viral time 9 (n) 11 (n) Park 5% 0.95 [0.57-1.62] death 940 (n) 1,567 (n) Wee 14% 0.86 [0.48-1.55] severe case population-based cohort Wee 35% 0.65 [0.50-0.85] hosp. population-based cohort Yang 2% 0.98 [0.95-1.00] death 220 (n) 1,061 (n) POSITIVES Edelstein -761% 8.61 [1.13-34.2] rebound 15/72 1/55 Kim 31% 0.69 [0.63-0.75] death population-based cohort Kim 43% 0.57 [0.53-0.60] severe case population-based cohort Dormuth 29% 0.71 [0.54-0.93] death/hosp. 85/3,433 120/3,433 confounding Dormuth 78% 0.22 [0.05-1.02] death/hosp. 2/280 9/280 confounding Dormuth 49% 0.51 [0.31-0.84] death/hosp. 23/1,314 45/1,314 confounding Dormuth 36% 0.64 [0.39-1.05] death/hosp. 25/1,050 39/1,050 confounding Dormuth -30% 1.30 [0.79-2.12] death/hosp. 35/789 27/789 confounding Dormuth 8% 0.92 [0.78-1.09] progression 232/3,280 252/3,280 confounding Dormuth 24% 0.76 [0.45-1.29] progression 22/264 29/264 confounding Dormuth 19% 0.81 [0.62-1.05] progression 93/1,259 115/1,259 confounding Dormuth -3% 1.03 [0.74-1.45] progression 64/1,018 62/1,018 confounding Dormuth -15% 1.15 [0.79-1.69] progression 53/739 46/739 confounding Lin -633% 7.33 [0.86-62.7] oxygen 4/30 1/55 Lin 35% 0.65 [0.43-0.98] recov. time 30 (n) 55 (n) Dalton (PSM) 8% 0.92 [0.91-0.93] PASC n/a n/a Dalton (PSM) -1% 1.01 [0.99-1.03] PASC n/a n/a Dalton (PSM) -7% 1.07 [1.02-1.12] PASC n/a n/a Fung 7% 0.93 [0.92-0.94] PASC population-based cohort LONG COVID Fung 13% 0.87 [0.86-0.88] PASC population-based cohort LONG COVID Low (PSM) 0% 1.00 [0.06-16.0] death 1/10,483 1/10,483 Low (PSM) 67% 0.33 [0.01-8.18] ICU 0/10,483 1/10,483 Low (PSM) 36% 0.64 [0.43-0.94] hosp. 42/10,483 67/10,483 Ioannou (PSM) 1% 0.99 [0.95-1.03] PASC 9,593 (n) 9,593 (n) LONG COVID Ioannou (PSM) 5% 0.95 [0.86-1.04] PASC 9,593 (n) 9,593 (n) LONG COVID Ioannou (PSM) -3% 1.03 [0.90-1.17] PASC 9,593 (n) 9,593 (n) LONG COVID Ioannou (PSM) 11% 0.89 [0.74-1.06] PASC 9,593 (n) 9,593 (n) LONG COVID Ioannou (PSM) 30% 0.70 [0.46-1.04] PASC 9,593 (n) 9,593 (n) LONG COVID Ioannou (PSM) 6% 0.94 [0.84-1.04] PASC 9,593 (n) 9,593 (n) LONG COVID Ioannou (PSM) -4% 1.04 [0.89-1.21] PASC 9,593 (n) 9,593 (n) LONG COVID Ioannou (PSM) -3% 1.03 [0.91-1.16] PASC 9,593 (n) 9,593 (n) LONG COVID Ioannou (PSM) -5% 1.05 [0.93-1.19] PASC 9,593 (n) 9,593 (n) LONG COVID Ioannou (PSM) 6% 0.94 [0.72-1.21] PASC 9,593 (n) 9,593 (n) LONG COVID Ioannou (PSM) -4% 1.04 [0.87-1.26] PASC 9,593 (n) 9,593 (n) LONG COVID Ioannou (PSM) -60% 1.60 [0.46-5.57] PASC 9,593 (n) 9,593 (n) LONG COVID Ioannou (PSM) -12% 1.12 [0.86-1.47] PASC 9,593 (n) 9,593 (n) LONG COVID Xu 12% 0.88 [0.76-1.02] hosp. time 195 (n) 120 (n) Xu 35% 0.65 [0.57-0.74] recov. time 195 (n) 120 (n) Xu 58% 0.42 [0.33-0.54] viral time 195 (n) 120 (n) Xu 47% 0.53 [0.29-0.97] PASC 195 (n) 120 (n) Durstenfeld (PSW) -14% 1.14 [0.83-1.54] PASC 57/353 176/1,258 LONG COVID Choi 37% 0.63 [0.46-0.86] death 251 (n) 1,592 (n) Choi -40% 1.40 [0.16-12.6] ICU 251 (n) 1,592 (n) Choi 20% 0.80 [0.31-2.04] oxygen 251 (n) 1,592 (n) Preiss 2% 0.98 [0.95-1.01] PASC population-based cohort LONG COVID Preiss 10% 0.90 [0.84-0.96] PASC population-based cohort LONG COVID Preiss 5% 0.95 [0.91-0.98] PASC population-based cohort LONG COVID Preiss 0% 1.00 [0.97-1.03] PASC population-based cohort LONG COVID Zhu -79% 1.79 [1.39-2.33] viral+ 138 (n) 155 (n) Cheng 22% 0.78 [0.60-1.00] death 2,083 (n) 2,045 (n) Cheng -1% 1.01 [0.74-1.37] oxygen 2,083 (n) 2,045 (n) Cheng 14% 0.86 [0.56-1.32] ICU 2,083 (n) 2,045 (n) Wang 13% 0.87 [0.46-1.63] death 66 (n) 55 (n) Wang -22% 1.22 [0.70-2.14] progression 66 (n) 55 (n) Henderson 84% 0.16 [0.05-0.50] hosp. confounding Yang 0% 1.00 [0.84-1.18] viral+ 362 (n) 724 (n) Yang 59% 0.41 [0.28-0.61] viral+ 362 (n) 724 (n) RECOVERY Horby (RCT) -1% 1.01 [0.43-2.40] death 9/68 9/69 RECOVERY Horby (RCT) -2% 1.02 [0.47-2.23] death 13/68 13/69 RECOVERY Horby (RCT) -1% 1.01 [0.06-15.9] ventilation 1/68 1/69 RECOVERY Horby (RCT) -35% 1.35 [0.76-2.42] no disch. 20/68 15/69 RECOVERY Horby (RCT) 19% 0.81 [0.76-0.86] viral load 68 (n) 69 (n) Choi 34% 0.66 [0.49-0.89] death 308 (n) 4,232 (n) Choi 37% 0.63 [0.28-1.38] ICU 308 (n) 4,232 (n) Choi 45% 0.55 [0.32-0.94] oxygen 308 (n) 4,232 (n) Low -30% 1.30 [0.76-2.21] PASC 1,289 (n) 1,235 (n) LONG COVID Low 29% 0.71 [0.31-1.64] PASC 1,289 (n) 1,235 (n) LONG COVID Yen 31% 0.69 [0.37-1.30] death 220 (n) 1,976 (n) Deng (PSM) -17% 1.17 [0.54-2.53] viral time 9 (n) 9 (n) Deng -105% 2.05 [0.19-22.3] misc. 21 (n) 21 (n) Yu 9% 0.91 [0.17-4.93] death 130 (all patients) Yu 34% 0.66 [0.45-0.99] no recov. 130 (all patients) Mikhail 0% 1.00 [0.40-2.41] progression 1,166 (n) 1,607 (n) Mikhail 33% 0.67 [0.40-1.14] hosp. 1,166 (n) 1,607 (n) Li 32% 0.68 [0.47-0.98] viral+ 40/83 130/224 Wan 28% 0.72 [0.62-0.84] death 541/6,604 2,541/17,283 Wan 24% 0.76 [0.70-0.82] hosp. 1,772/6,604 2,541/17,283 Wan 18% 0.82 [0.76-0.88] progression 1,816/6,604 2,541/17,283 Wan 23% 0.77 [0.66-0.90] death 1,813 (n) 5,306 (n) Wan -3% 1.03 [0.70-1.52] ventilation 1,813 (n) 5,306 (n) Wan -8% 1.08 [0.58-2.02] ICU 1,813 (n) 5,306 (n) Shao 29% 0.71 [0.44-1.14] death 280 (n) 802 (n) Shao -28% 1.28 [1.13-1.45] HRQoL 237 (n) 456 (n) Fu -280% 3.80 [0.41-35.4] ventilation 3/49 1/62 OT1 Fu -659% 7.59 [0.95-61.0] ICU 6/49 1/62 OT1 Fu -207% 3.07 [1.39-6.81] progression 17/49 7/62 OT1 Shao 29% 0.71 [0.44-1.14] death 280 (n) 509 (n) Shao -28% 1.28 [1.13-1.45] misc. 237 (n) 456 (n) Yu (RCT) -2% 1.02 [0.21-4.93] severe case 3/103 3/105 OT1 Yu (RCT) -6% 1.06 [0.79-1.43] no disch. 49/103 47/105 OT1 Yu (RCT) 12% 0.88 [0.66-1.18] viral+ 30/103 34/105 OT1 Dian (PSM) -175% 2.75 [0.89-8.51] death 11/228 4/228 OT1 Dian (PSM) -200% 3.00 [0.61-14.7] ventilation 6/228 2/228 OT1 Dian (PSM) 0% 1.00 [0.06-15.9] ICU 1/228 1/228 OT1 Dian (PSM) -94% 1.94 [1.09-3.44] progression 31/228 16/228 OT1 Dian (PSM) -80% 1.80 [0.98-3.29] progression 27/228 15/228 OT1 Li 18% 0.82 [0.47-1.43] death 14/73 35/150 Zhou -39% 1.39 [1.02-1.89] death 52/132 54/190 Zhou 22% 0.78 [0.56-1.09] death 37/131 69/191 Wei 0% 1.00 [0.68-1.46] death 36/264 63/461 OT1 Wei -38% 1.38 [1.02-1.87] ventilation 61/264 77/461 OT1 Wei -122% 2.22 [0.98-5.03] ICU 14/264 11/461 OT1 Wei -28% 1.28 [0.99-1.67] progression 72/264 98/461 OT1 Guo -10% 1.10 [1.01-1.20] viral time 779 (n) 1,199 (n) Lu -6% 1.06 [0.77-1.47] death 17/29 140/253 Liu -94% 1.94 [1.24-3.03] progression 27/145 41/427 Liu 24% 0.76 [0.42-1.37] progression 12/126 56/446 Peng -79% 1.79 [0.43-7.42] death 21 (n) 145 (n) Chen (PSM) 0% 1.00 [0.42-2.37] death 10/324 10/324 Chen (PSM) 80% 0.20 [0.02-1.70] ventilation 1/324 5/324 Chen (PSM) 0% 1.00 [0.33-3.07] severe case 6/324 6/324 Chen (PSM) 27% 0.73 [0.30-1.78] oxygen 8/324 11/324 Chen 1% 0.99 [0.84-1.16] viral time 324 (n) 324 (n) Chen -6% 1.06 [0.91-1.23] viral+ 171/324 162/324 Liu (PSM) -272% 3.72 [1.02-13.6] progression 148 (all patients) Lv -495% 5.95 [2.72-13.0] death 35/148 7/176 Lai 20% 0.80 [0.68-0.95] death 5,165 (n) 4,388 (n) Pfizer (DB RCT) 8% 0.92 [0.72-1.18] no recov. 186 (n) 99 (n) Pfizer (DB RCT) 18% 0.82 [0.73-0.91] viral load 218 (n) 113 (n) Pfizer (DB RCT) 19% 0.81 [0.64-1.02] viral+ 223 (n) 115 (n) EPIC-PEP Pfizer (DB RCT) 67% 0.33 [0.01-8.20] hosp. 0/830 1/840 EPIC-PEP Pfizer (DB RCT) 67% 0.33 [0.01-8.16] hosp. 0/844 1/840 EPIC-PEP Pfizer (DB RCT) 25% 0.75 [0.40-1.39] severe case 17/830 23/840 EPIC-PEP Pfizer (DB RCT) 22% 0.78 [0.42-1.43] severe case 18/844 23/840 EPIC-PEP Pfizer (DB RCT) 15% 0.85 [0.66-1.09] progression 830 (n) 840 (n) EPIC-PEP Pfizer (DB RCT) 3% 0.97 [0.76-1.24] progression 844 (n) 840 (n) EPIC-PEP Pfizer (DB RCT) 36% 0.65 [0.37-1.11] symp. case 830 (n) 840 (n) EPIC-PEP Pfizer (DB RCT) 30% 0.70 [0.42-1.17] symp. case 844 (n) 840 (n) EPIC-PEP Pfizer (DB RCT) 5% 0.95 [0.65-1.41] symp. case 887 (n) 873 (n) EPIC-PEP Pfizer (DB RCT) 27% 0.73 [0.48-1.10] symp. case 889 (n) 873 (n) Paxlovid COVID-19 outcomes c19 earlyDecember 2024 1 OT: comparison with other treatment Favors paxlovid Favors control
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