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Real-World Effectiveness of Ensitrelvir in Reducing Severe Outcomes in Outpatients at High Risk for COVID-19

Takazono et al., Infectious Diseases and Therapy, doi:10.1007/s40121-024-01010-4, Jun 2024
https://c19early.org/takazono.html
Mortality -24% Improvement Relative Risk Ventilation -158% ICU admission 97% Oxygen therapy 36% Hospitalization 37% Ensitrelvir  Takazono et al.  EARLY TREATMENT Is early treatment with ensitrelvir beneficial for COVID-19? Retrospective 167,310 patients in Japan (November 2022 - July 2023) Lower hospitalization with ensitrelvir (p=0.024) c19early.org Takazono et al., Infectious Diseases a.., Jun 2024 Favorsensitrelvir Favorscontrol 0 0.5 1 1.5 2+
48th treatment shown to reduce risk in July 2023, now with p = 0.028 from 7 studies.
No treatment is 100% effective. Protocols combine treatments.
5,800+ studies for 172 treatments. c19early.org
Retrospective 167,310 high-risk COVID-19 outpatients in Japan showing significantly lower hospitalization with ensitrelvir treatment.
Standard of Care (SOC) for COVID-19 in the study country, Japan, is very poor with very low average efficacy for approved treatments1. Only expensive, high-profit treatments were approved for early treatment. Low-cost treatments were excluded, reducing the probability of early treatment due to access and cost barriers, and eliminating complementary and synergistic benefits seen with many low-cost treatments.
risk of death, 23.7% higher, RR 1.24, p = 0.84, treatment 5,177, control 162,133, propensity score weighting.
risk of mechanical ventilation, 158.5% higher, RR 2.58, p = 0.20, treatment 5,177, control 162,133, propensity score weighting.
risk of ICU admission, 97.3% lower, RR 0.03, p = 0.63, treatment 0 of 5,177 (0.0%), control 35 of 162,133 (0.0%), NNT 4632, relative risk is not 0 because of continuity correction due to zero events (with reciprocal of the contrasting arm).
risk of oxygen therapy, 36.5% lower, RR 0.64, p = 0.33, treatment 5,177, control 162,133, propensity score weighting.
risk of hospitalization, 37.1% lower, RR 0.63, p = 0.02, treatment 5,177, control 162,133, propensity score weighting.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Takazono et al., 28 Jun 2024, retrospective, Japan, peer-reviewed, 13 authors, study period November 2022 - July 2023. Contact: satoki.fujita@shionogi.co.jp.
Real-World Effectiveness of Ensitrelvir in Reducing Severe Outcomes in Outpatients at High Risk for COVID-19
Takahiro Takazono, Satoki Fujita, Takuji Komeda, Shogo Miyazawa, Yuki Yoshida, Yoshitake Kitanishi, Masahiro Kinoshita, Satoshi Kojima, Huilian Shen, Takeki Uehara, Naoki Hosogaya, Naoki Iwanaga, Hiroshi Mukae
Infectious Diseases and Therapy, doi:10.1007/s40121-024-01010-4
Introduction: This study aimed to evaluate the effectiveness of ensitrelvir, an oral antiviral, in reducing hospitalization risk in outpatients at high-risk for severe COVID-19 during the Omicron era. Methods: This was a retrospective study using a large Japanese health insurance claims database. It included high-risk outpatients for severe symptoms who received their first COVID-19 diagnosis between November 2022 and July 2023. The study included outpatients aged ≥ 18 years. The primary endpoint was all-cause hospitalization during the 4-week period from the date of outpatient diagnosis and medication, comparing the ensitrelvir group (n = 5177) and the no antiviral treatment group (n = 162,133). The risk ratio and risk difference were evaluated after adjusting patient background distribution by the inverse probability of treatment weight (IPTW) method. Secondary endpoints were incidence of respiratory and heart rate monitoring, oxygen therapy, ventilator use, intensive care admission, and all-cause death. Results: The risk ratio for all-cause hospitalization between the ensitrelvir group (n = 167,385) and the no antiviral treatment group (n = 167,310) after IPTW adjustment was 0.629 [95% confidence interval (CI) 0.420, 0.943]. The risk difference was -0.291 [95% CI -0.494, -0.088]. The incidence of both respiratory and
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DOI record: { "DOI": "10.1007/s40121-024-01010-4", "ISSN": [ "2193-8229", "2193-6382" ], "URL": "http://dx.doi.org/10.1007/s40121-024-01010-4", "alternative-id": [ "1010" ], "assertion": [ { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Received", "name": "received", "order": 1, "value": "29 April 2024" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Accepted", "name": "accepted", "order": 2, "value": "14 June 2024" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "First Online", "name": "first_online", "order": 3, "value": "28 June 2024" }, { "group": { "label": "Declarations", "name": "EthicsHeading" }, "name": "Ethics", "order": 1 }, { "group": { "label": "Conflict of Interest", "name": "EthicsHeading" }, "name": "Ethics", "order": 2, "value": "Satoki Fujita, Takuji Komeda, Shogo Miyazawa, Yuki Yoshida, Yoshitake Kitanishi, Masahiro Kinoshita, Satoshi Kojima, Huilian Shen, and Takeki Uehara are employees of Shionogi & Co., Ltd. and may hold stocks in the company. Takahiro Takazono has received personal fees from Shionogi & Co., Ltd., MSD K.K., Pfizer Japan Inc., Insmed GK., Asahi Kasei Pharma Corporation, and Kyorin Pharmaceutical Co., Ltd. Hiroshi Mukae has also received personal fees from AbbVie GK., Asahi Kasei Pharma Corporation, Astellas Pharma Inc., AstraZeneca K.K., Bristol-Myers Squibb K.K., Eli Lilly Japan K.K., FUJIFILM Toyama Chemical Co., Ltd., Gilead Sciences Inc., Insmed GK., Janssen Pharmaceutical K.K., Kyorin Pharmaceutical Co., Ltd., Meiji Seika Pharma Co., Ltd., Mitsubishi Tanabe Pharma Corporation, MSD K.K., Nihon Pharmaceutical Co., Ltd., Nippon Boehringer Ingelheim Co., Ltd., Novartis Pharma K.K., Pfizer Japan Inc., Sumitomo Pharma Co., Ltd., Taiho Pharmaceutical Co., Ltd., Taisho Pharma Co., Ltd., Teijin Healthcare Ltd., and Toa Shinyaku Co., Ltd., and grants from Asahi Kasei Pharma Corporation, Astellas Pharma Inc., FUJIFILM Toyama Chemical Co., Ltd., Kyorin Pharmaceutical Co., Ltd., Meiji Seika Pharma Co., Ltd., Pfizer Japan Inc., Taiho Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Teijin Pharma Ltd., Toa Shinyaku Co., Ltd., and Torii Pharmaceutical Co., Ltd., outside the submitted work. 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D220 Respiratory Heart Rate Monitoring, Neonatal Heart Rate and Respiratory Monitoring, Cardioscope (Heart Scope). Notification from the Insurance Bureau. Implementation Considerations for the Partial Revision of the Calculation Method for Medical Reimbursement. 2022; No.0304-1, Mar 4: 346–347. https://kouseikyoku.mhlw.go.jp/kyushu/000215073.pdf. Accessed May 30, 2024 (in Japanese)." }, { "key": "1010_CR30", "unstructured": "Ministry of Health, Labour and Welfare. Number of newly confirmed cases by age (weekly). Visualizing the data: information on COVID-19 infections. https://covid19.mhlw.go.jp/en/. Accessed May 30, 2024 (in Japanese)." }, { "key": "1010_CR31", "unstructured": "ClinicalTrials.gov. Strategies and treatments for respiratory infections & viral emergencies (STRIVE): Shionogi protease inhibitor. NCT05605093. https://clinicaltrials.gov/study/NCT05605093. Accessed May 30, 2024." }, { "key": "1010_CR32", "unstructured": "Centers for Disease Control and Prevention. 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Accessed May 30, 2024 (in Japanese). https://www.mhlw.go.jp/content/10900000/000987057.pdf." } ], "reference-count": 34, "references-count": 34, "relation": {}, "resource": { "primary": { "URL": "https://link.springer.com/10.1007/s40121-024-01010-4" } }, "score": 1, "short-title": [], "source": "Crossref", "subject": [], "subtitle": [], "title": "Real-World Effectiveness of Ensitrelvir in Reducing Severe Outcomes in Outpatients at High Risk for COVID-19", "type": "journal-article", "update-policy": "https://doi.org/10.1007/springer_crossmark_policy", "volume": "13" }
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Please send us corrections, updates, or comments. c19early involves the extraction of 200,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. IMA and WCH provide treatment protocols.
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