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0 0.5 1 1.5 2+ Time to viral- 20% Improvement Relative Risk Paxlovid for COVID-19  Shao et al.  EARLY TREATMENT Is early treatment with paxlovid beneficial for COVID-19? Retrospective 131 patients in China (April - May 2022) Study compares with lianhuaqingwen, results vs. placebo may differ Faster viral clearance with paxlovid (p=0.00056) c19early.org Shao et al., medRxiv, July 2022 Favors paxlovid Favors lianhuaqingwen

Clinical advancement of patients infected with SARS-CoV-2 Omicron variant in Shanghai, China

Shao et al., medRxiv, doi:10.1101/2022.07.03.22277169
Jul 2022  
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Retrospective 17 paxlovid and 114 lianhuaqingwen patients in China, showing faster viral clearance with paxlovid.
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.
This study is excluded in the after exclusion results of meta analysis: unadjusted results with no group details.
time to viral-, 20.0% lower, relative time 0.80, p < 0.001, treatment 17, control 114.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Shao et al., 6 Jul 2022, retrospective, China, preprint, median age 52.0, 12 authors, study period 6 April, 2022 - 11 May, 2022, this trial compares with another treatment - results may be better when compared to placebo. Contact: huanggang@sumhs.edu.cn, hujianrong@jdhospital.com.
This PaperPaxlovidAll
Clinical advancement of patients infected with SARS-CoV-2 Omicron variant in Shanghai, China
Jiasheng Shao, Rong Fan, Tiejun Zhang, Catherine Lee, Xuyuan Huang, Fei Wang, Haiying Liang, Ye Jin, Ying Jiang, Yanhua Gu, Jianrong Hu, Gang Huang
doi:10.1101/2022.07.03.22277169
All rights reserved. No reuse allowed without permission. (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
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{ 'DOI': '10.1101/2022.07.03.22277169', 'URL': 'http://dx.doi.org/10.1101/2022.07.03.22277169', 'abstract': '<jats:p>Background\n' '\n' 'Studies on the Omicron variant infection have generally been restricted to descriptions of ' 'its initial clinical and epidemiological characteristics, we investigated the ' 'timeline-related advancement in individuals with Omicron variant.\n' '\n' 'Methods\n' ' \n' 'We conducted a retrospective, single centered study including 226 laboratory confirmed cases ' 'with Omicron variant between April 6th and May 11th, 2022 in Shanghai, China. Final date of ' 'follow-up was May 30, 2022.\n' '\n' 'Results\n' '\n' 'Among 226 enrolled patients, the median age was 52 years old, and 118 (52.2%) were female. ' 'The duration from onset of symptoms to hospitalization was 3 (IQR, 2-4) days for symptomatic ' 'patients. Cough occurred in 168 patients (74.3% ). The median interval to negative ' 'reverse-transcriptase PCR tests of nasopharynx swab was 10 days (interquartile range [IQR]: ' '8-13 days). No radiographic progressions were found in 196 patients on the 7th day after ' 'onset of symptoms. The median duration of fever in all participants was 5 days (IQR: 4-6 ' 'days). The median PCR conversion time of Paxlovid-treated patients was 8 days (IQR: 7-10 ' 'days) compared with that of Lianhuaqingwen (10 days, IQR: 8-13 days) (p=0.00056). Booster ' 'vaccination can significantly decrease the severity of Omicron infection when compared with ' 'unvaccinated, partially or fully vaccinated patients (p=0.009). The median time of PCR ' 'conversion in individuals aged under 14 recovered significantly faster than older patients ' '(median 8 days versus 11 days, P &lt; 0.0001). In multivariate logistic analysis, erythrocyte ' 'sedimentation rate (ESR) (OR=1.05) was independently related to the severity of the ' 'infection.\n' ' \n' 'Conclusions\n' '\n' 'The majority clinical symptoms of Omicron infection were not severe. Early and aggressive ' 'administration of Paxlovid can significantly reduce the PCR conversion time. Booster ' 'vaccination should also be highly recommended in population over 14 years old.</jats:p>', 'accepted': {'date-parts': [[2022, 7, 5]]}, 'author': [ {'affiliation': [], 'family': 'Shao', 'given': 'Jiasheng', 'sequence': 'first'}, {'affiliation': [], 'family': 'Fan', 'given': 'Rong', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Zhang', 'given': 'Tiejun', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Lee', 'given': 'Catherine', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Huang', 'given': 'Xuyuan', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Wang', 'given': 'Fei', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Liang', 'given': 'Haiying', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Jin', 'given': 'Ye', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Jiang', 'given': 'Ying', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Gu', 'given': 'Yanhua', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Hu', 'given': 'Jianrong', 'sequence': 'additional'}, {'affiliation': [], 'family': 'Huang', 'given': 'Gang', 'sequence': 'additional'}], 'container-title': [], 'content-domain': {'crossmark-restriction': False, 'domain': []}, 'created': {'date-parts': [[2022, 7, 6]], 'date-time': '2022-07-06T14:30:14Z', 'timestamp': 1657117814000}, 'deposited': { 'date-parts': [[2022, 7, 6]], 'date-time': '2022-07-06T14:30:15Z', 'timestamp': 1657117815000}, 'group-title': 'Infectious Diseases (except HIV/AIDS)', 'indexed': {'date-parts': [[2022, 7, 6]], 'date-time': '2022-07-06T15:17:16Z', 'timestamp': 1657120636413}, 'institution': [{'name': 'medRxiv'}], 'is-referenced-by-count': 0, 'issued': {'date-parts': [[2022, 7, 6]]}, 'link': [ { 'URL': 'https://syndication.highwire.org/content/doi/10.1101/2022.07.03.22277169', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'member': '246', 'original-title': [], 'posted': {'date-parts': [[2022, 7, 6]]}, 'prefix': '10.1101', 'published': {'date-parts': [[2022, 7, 6]]}, 'publisher': 'Cold Spring Harbor Laboratory', 'reference-count': 0, 'references-count': 0, 'relation': {}, 'resource': {'primary': {'URL': 'http://medrxiv.org/lookup/doi/10.1101/2022.07.03.22277169'}}, 'score': 1, 'short-title': [], 'source': 'Crossref', 'subtitle': [], 'subtype': 'preprint', 'title': 'Clinical advancement of patients infected with SARS-CoV-2 Omicron variant in Shanghai, China', 'type': 'posted-content'}
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