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 .
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 . Population studies often do not account for the different expected outcomes for the class of patients that seek out and receive early treatment.
0
0.5
1
1.5+
All studies
28%
38
79,907
Improvement, Studies, Patients
Relative Risk
Mortality
45%
18
53,317
Ventilation
1%
5
5,329
ICU admission
1%
6
4,889
Hospitalization
37%
14
48,708
Progression
17%
9
38,087
Recovery
-5%
6
2,423
Cases
36%
1
1,670
Viral clearance
16%
13
4,360
RCTs
48%
5
5,372
RCT mortality
70%
3
3,494
Peer-reviewed
29%
26
48,920
Prophylaxis
67%
1
1,670
Early
32%
33
53,041
Late
28%
5
25,595
Paxlovid for COVID-19
c19 early .org Oct 2023
after exclusions
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
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 65+
79%
0.21 [0.05-0.82]
death
Arbel 40-64
-32%
1.32 [0.16-10.8]
death
Najjar-Debbiny
46%
0.54 [0.39-0.75]
severe case
population-based cohort
Pfizer (DB RCT)
67%
0.33 [0.01-8.13]
death
0/576
1/569
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
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
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
Durstenfeld (PSW)
-14%
1.14 [0.83-1.54]
PASC
57/353
176/1,258
LONG COVID
Lewnard
84%
0.16 [0.03-0.81]
death/ICU
n/a
n/a
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
Tau2 = 0.07, I2 = 90.0%, p < 0.0001
Early treatment
32%
0.68 [0.60-0.77]
214/20,019
623.6/33,022
32% 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
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
Yu (RCT)
-2%
1.02 [0.21-4.93]
severe case
3/103
3/105
OT1
Tau2 = 0.00, I2 = 0.0%, p < 0.0001
Late treatment
28%
0.72 [0.66-0.78]
587/7,119
2,675/18,476
28% lower risk
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
28%
0.72 [0.64-0.80]
801/27,968
3,299.6/52,338
28% lower risk
Paxlovid COVID-19 studies
c19 early .org
October 2023
Tau2 = 0.06, I2 = 88.4%, 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)
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 65+
79%
0.21 [0.05-0.82]
death
Arbel 40-64
-32%
1.32 [0.16-10.8]
death
Najjar-Debbiny
46%
0.54 [0.39-0.75]
severe case
population-based cohort
Pfizer (DB RCT)
67%
0.33 [0.01-8.13]
death
0/576
1/569
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
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
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
Durstenfeld (PSW)
-14%
1.14 [0.83-1.54]
PASC
57/353
176/1,258
LONG COVID
Lewnard
84%
0.16 [0.03-0.81]
death/ICU
n/a
n/a
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
Tau2 = 0.09, I2 = 90.5%, p < 0.0001
Early treatment
34%
0.66 [0.57-0.76]
129/16,552
503.6/29,361
34% 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
Shao
29%
0.71 [0.44-1.14]
death
280 (n)
802 (n)
Yu (RCT)
-2%
1.02 [0.21-4.93]
severe case
3/103
3/105
OT1
Tau2 = 0.00, I2 = 0.0%, p < 0.0001
Late treatment
28%
0.72 [0.66-0.78]
584/7,070
2,674/18,414
28% lower risk
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
30%
0.70 [0.62-0.80]
713/24,452
3,178.6/48,615
30% lower risk
Paxlovid COVID-19 studies after exclusions
c19 early .org
October 2023
Tau2 = 0.07, I2 = 89.1%, 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)
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 65+
79%
0.21 [0.05-0.82]
Arbel 40-64
-32%
1.32 [0.16-10.8]
Pfizer (DB RCT)
67%
0.33 [0.01-8.13]
0/576
1/569
Ganatra (PSM)
95%
0.05 [0.00-0.81]
0/1,130
10/1,130
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]
Liu (RCT)
38%
0.62 [0.21-1.86]
5/132
8/132
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
Tau2 = 0.13, I2 = 93.2%, p < 0.0001
Early treatment
50%
0.50 [0.39-0.65]
39/9,395
196.6/18,953
50% lower risk
Wan
28%
0.72 [0.62-0.84]
541/6,604
2,541/17,283
Improvement, RR [CI]
Treatment
Control
Shao
29%
0.71 [0.44-1.14]
280 (n)
802 (n)
Tau2 = 0.00, I2 = 0.0%, p < 0.0001
Late treatment
28%
0.72 [0.66-0.78]
541/6,884
2,541/18,085
28% lower risk
All studies
45%
0.55 [0.44-0.67]
580/16,279
2,737.6/37,038
45% lower risk
18 paxlovid COVID-19 mortality results
c19 early .org
October 2023
Tau2 = 0.10, I2 = 93.4%, p < 0.0001
Favors paxlovid
Favors control
0
0.25
0.5
0.75
1
1.25
1.5
1.75
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
Liu (RCT)
-67%
1.67 [0.62-4.45]
10/132
6/132
Tau2 = 0.00, I2 = 0.0%, p = 0.77
Early treatment
8%
0.92 [0.53-1.58]
13/2,609
11.8/2,609
8% lower risk
Fu
-280%
3.80 [0.41-35.4]
3/49
1/62
OT1
Improvement, RR [CI]
Treatment
Control
Tau2 = 0.00, I2 = 0.0%, p = 0.24
Late treatment
-280%
3.80 [0.41-35.4]
3/49
1/62
280% higher risk
All studies
1%
0.99 [0.58-1.70]
16/2,658
12.8/2,671
1% lower risk
5 paxlovid COVID-19 mechanical ventilation results
c19 early .org
October 2023
Tau2 = 0.01, I2 = 2.1%, p = 0.99
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+
Pfizer (DB RCT)
86%
0.14 [0.01-2.75]
0/576
3/569
Improvement, RR [CI]
Treatment
Control
Wong (PSM)
-58%
1.58 [0.95-2.63]
Bajema (PSM)
56%
0.44 [0.21-0.92]
10/1,587
22.8/1,587
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
Tau2 = 0.17, I2 = 59.4%, p = 0.66
Early treatment
11%
0.89 [0.54-1.47]
27/2,368
58.8/2,410
11% lower risk
Fu
-659%
7.59 [0.95-61.0]
6/49
1/62
OT1
Improvement, RR [CI]
Treatment
Control
Tau2 = 0.00, I2 = 0.0%, p = 0.056
Late treatment
-659%
7.59 [0.95-61.0]
6/49
1/62
659% higher risk
All studies
1%
0.99 [0.57-1.70]
33/2,417
59.8/2,472
1% lower risk
6 paxlovid COVID-19 ICU results
c19 early .org
October 2023
Tau2 = 0.25, I2 = 63.0%, p = 0.96
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)
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 65+
73%
0.27 [0.15-0.49]
hosp.
Arbel 40-64
26%
0.74 [0.35-1.58]
hosp.
Ganatra (PSM)
56%
0.44 [0.21-0.91]
hosp.
10/1,130
23/1,130
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.
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
Tau2 = 0.10, I2 = 92.6%, p < 0.0001
Early treatment
41%
0.59 [0.48-0.74]
232/7,527
1,034.2/15,624
41% 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
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
37%
0.63 [0.54-0.75]
2,004/14,961
3,576.2/33,747
37% lower risk
14 paxlovid COVID-19 hospitalization results
c19 early .org
October 2023
Tau2 = 0.06, I2 = 91.7%, p < 0.0001
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
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 65+
79%
0.21 [0.05-0.82]
death
Arbel 40-64
-32%
1.32 [0.16-10.8]
death
Najjar-Debbiny
46%
0.54 [0.39-0.75]
severe case
population-based cohort
Pfizer (DB RCT)
67%
0.33 [0.01-8.13]
death
0/576
1/569
Ganatra (PSM)
95%
0.05 [0.00-0.81]
death
0/1,130
10/1,130
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
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
Durstenfeld (PSW)
-14%
1.14 [0.83-1.54]
PASC
57/353
176/1,258
LONG COVID
Lewnard
84%
0.16 [0.03-0.81]
death/ICU
n/a
n/a
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
Tau2 = 0.11, I2 = 90.4%, p < 0.0001
Early treatment
39%
0.61 [0.51-0.72]
181/19,623
492.6/32,468
39% lower risk
Wan
28%
0.72 [0.62-0.84]
death
541/6,604
2,541/17,283
Improvement, RR [CI]
Treatment
Control
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
Yu (RCT)
-2%
1.02 [0.21-4.93]
severe case
3/103
3/105
OT1
Tau2 = 0.00, I2 = 0.0%, p < 0.0001
Late treatment
28%
0.72 [0.66-0.79]
547/7,036
2,545/18,252
28% lower risk
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
37%
0.63 [0.54-0.74]
728/27,489
3,038.6/51,560
37% lower risk
30 paxlovid COVID-19 serious outcomes
c19 early .org
October 2023
Tau2 = 0.09, I2 = 89.9%, 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)
21%
0.79 [0.69-0.90]
recov. time
686 (n)
674 (n)
Improvement, RR [CI]
Treatment
Control
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)
Tau2 = 0.05, I2 = 81.8%, p = 0.87
Early treatment
2%
0.98 [0.77-1.24]
0/801
0/721
2% 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
Tau2 = 0.00, I2 = 25.2%, p = 0.011
Late treatment
-23%
1.23 [1.05-1.43]
49/340
47/561
23% higher risk
All studies
-5%
1.05 [0.85-1.29]
49/1,141
47/1,282
5% higher risk
6 paxlovid COVID-19 recovery results
c19 early .org
October 2023
Tau2 = 0.06, I2 = 86.4%, p = 0.69
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+
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]
0/830
0/840
36% lower risk
All studies
36%
0.65 [0.37-1.11]
0/830
0/840
36% lower risk
1 paxlovid COVID-19 case result
c19 early .org
October 2023
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)
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
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
Tau2 = 0.03, I2 = 83.0%, p < 0.0001
Early treatment
22%
0.78 [0.69-0.88]
33/2,020
131/2,224
22% 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
Tau2 = 0.00, I2 = 9.9%, p = 0.0083
Late treatment
27%
0.73 [0.58-0.92]
70/186
164/329
27% lower risk
All studies
16%
0.84 [0.78-0.90]
103/2,206
295/2,553
16% lower risk
14 paxlovid COVID-19 viral clearance results
c19 early .org
October 2023
Tau2 = 0.01, I2 = 59.5%, 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
Pfizer (DB RCT)
67%
0.33 [0.01-8.13]
death
0/576
1/569
Liu (RCT)
38%
0.62 [0.21-1.86]
death
5/132
8/132
Tau2 = 0.82, I2 = 37.2%, p = 0.13
Early treatment
70%
0.30 [0.06-1.46]
5/1,747
21/1,747
70% lower risk
Yu (RCT)
-2%
1.02 [0.21-4.93]
severe case
3/103
3/105
OT1
Improvement, RR [CI]
Treatment
Control
Tau2 = 0.00, I2 = 0.0%, p = 0.98
Late treatment
-2%
1.02 [0.21-4.93]
3/103
3/105
2% higher risk
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
48%
0.52 [0.23-1.19]
8/2,680
25/2,692
48% lower risk
5 paxlovid COVID-19 Randomized Controlled Trials
c19 early .org
October 2023
Tau2 = 0.03, I2 = 2.8%, p = 0.12
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)
96%
0.04 [0.00-0.68]
0/1,039
12/1,046
Improvement, RR [CI]
Treatment
Control
Pfizer (DB RCT)
67%
0.33 [0.01-8.13]
0/576
1/569
Liu (RCT)
38%
0.62 [0.21-1.86]
5/132
8/132
Tau2 = 0.82, I2 = 37.2%, p = 0.13
Early treatment
70%
0.30 [0.06-1.46]
5/1,747
21/1,747
70% lower risk
All studies
70%
0.30 [0.06-1.46]
5/1,747
21/1,747
70% lower risk
3 paxlovid COVID-19 RCT mortality results
c19 early .org
October 2023
Tau2 = 0.82, I2 = 37.2%, p = 0.13
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
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 65+
79%
0.21 [0.05-0.82]
death
Arbel 40-64
-32%
1.32 [0.16-10.8]
death
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
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
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
Durstenfeld (PSW)
-14%
1.14 [0.83-1.54]
PASC
57/353
176/1,258
LONG COVID
Lewnard
84%
0.16 [0.03-0.81]
death/ICU
n/a
n/a
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
Tau2 = 0.09, I2 = 82.8%, p < 0.0001
Early treatment
35%
0.65 [0.55-0.76]
172/8,899
473/14,936
35% 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
Shao
29%
0.71 [0.44-1.14]
death
280 (n)
802 (n)
Yu (RCT)
-2%
1.02 [0.21-4.93]
severe case
3/103
3/105
OT1
Tau2 = 0.00, I2 = 0.0%, p < 0.0001
Late treatment
28%
0.72 [0.66-0.78]
584/7,070
2,674/18,414
28% lower risk
All studies
29%
0.71 [0.63-0.80]
756/15,969
3,147/33,350
29% lower risk
27 paxlovid COVID-19 peer reviewed studies
c19 early .org
October 2023
Tau2 = 0.04, I2 = 74.6%, 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)
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)
21%
0.79 [0.69-0.90]
recov. time
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 65+
79%
0.21 [0.05-0.82]
death
Arbel 65+
-32%
1.32 [0.16-10.8]
death
Arbel 65+
73%
0.27 [0.15-0.49]
hosp.
Arbel 65+
26%
0.74 [0.35-1.58]
hosp.
Arbel 40-64
-32%
1.32 [0.16-10.8]
death
Arbel 40-64
26%
0.74 [0.35-1.58]
hosp.
Najjar-Debbiny
46%
0.54 [0.39-0.75]
severe case
population-based cohort
Pfizer (DB RCT)
67%
0.33 [0.01-8.13]
death
0/576
1/569
Pfizer (DB RCT)
86%
0.14 [0.01-2.75]
ICU
0/576
3/569
Pfizer (DB RCT)
51%
0.49 [0.17-1.44]
death/hosp.
5/576
10/569
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
Ganatra (PSM)
39%
0.61 [0.42-0.70]
progression
89/1,130
163/1,130
Ganatra (PSM)
33%
0.67 [0.52-0.87]
progression
89/1,130
163/1,130
Ganatra (PSM)
56%
0.44 [0.21-0.91]
hosp.
10/1,130
23/1,130
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
Dryden-Peterson
44%
0.56 [0.42-0.75]
death/hosp.
Dryden-Peterson
40%
0.60 [0.44-0.81]
hosp.
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)
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)
Durstenfeld (PSW)
-14%
1.14 [0.83-1.54]
PASC
57/353
176/1,258
LONG COVID
Lewnard
84%
0.16 [0.03-0.81]
death/ICU
n/a
n/a
Lewnard
89%
0.11 [0.01-1.25]
death/ICU
n/a
n/a
Lewnard
54%
0.46 [0.23-0.93]
death/hosp.
n/a
n/a
Lewnard
80%
0.20 [0.06-0.66]
death/hosp.
n/a
n/a
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
Dormuth
78%
0.22 [0.05-1.02]
death/hosp.
2/280
9/280
Dormuth
49%
0.51 [0.31-0.84]
death/hosp.
23/1,314
45/1,314
Dormuth
36%
0.64 [0.39-1.05]
death/hosp.
25/1,050
39/1,050
Dormuth
-30%
1.30 [0.79-2.12]
death/hosp.
35/789
27/789
Dormuth
8%
0.92 [0.78-1.09]
progression
232/3,280
252/3,280
Dormuth
24%
0.76 [0.45-1.29]
progression
22/264
29/264
Dormuth
19%
0.81 [0.62-1.05]
progression
93/1,259
115/1,259
Dormuth
-3%
1.03 [0.74-1.45]
progression
64/1,018
62/1,018
Dormuth
-15%
1.15 [0.79-1.69]
progression
53/739
46/739
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
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
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
Pfizer (DB RCT)
67%
0.33 [0.01-8.20]
hosp.
0/830
1/840
Pfizer (DB RCT)
67%
0.33 [0.01-8.16]
hosp.
0/844
1/840
Pfizer (DB RCT)
25%
0.75 [0.40-1.39]
severe case
17/830
23/840
Pfizer (DB RCT)
22%
0.78 [0.42-1.43]
severe case
18/844
23/840
Pfizer (DB RCT)
15%
0.85 [0.66-1.09]
progression
830 (n)
840 (n)
Pfizer (DB RCT)
3%
0.97 [0.76-1.24]
progression
844 (n)
840 (n)
Pfizer (DB RCT)
36%
0.65 [0.37-1.11]
symp. case
830 (n)
840 (n)
Pfizer (DB RCT)
30%
0.70 [0.42-1.17]
symp. case
844 (n)
840 (n)
Pfizer (DB RCT)
5%
0.95 [0.65-1.41]
symp. case
887 (n)
873 (n)
Pfizer (DB RCT)
27%
0.73 [0.48-1.10]
symp. case
889 (n)
873 (n)
Paxlovid COVID-19 outcomes
c19 early .org
October 2023
1 OT: comparison with other treatment
Favors paxlovid
Favors control
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