Nirmatrelvir/Ritonavir Use and Hospitalizations or Death in a Previously Uninfected Nonhospitalized High-Risk Population With COVID-19: A Matched Cohort Study

Abstract Objective To determine the association of nirmatrelvir/ritonavir (NMV/r) with hospitalization or death within 30 days as compared with untreated controls previously uninfected and nonhospitalized. Methods We used a matched cohort design using inverse probability of treatment weight (IPTW)....

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Veröffentlicht in:The Journal of infectious diseases 2024-01, Vol.229 (1), p.147-154
Hauptverfasser: Butt, Adeel A, Yan, Peng, Shaikh, Obaid S, Talisa, Victor B, Omer, Saad B, Mayr, Florian B
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Sprache:eng
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Zusammenfassung:Abstract Objective To determine the association of nirmatrelvir/ritonavir (NMV/r) with hospitalization or death within 30 days as compared with untreated controls previously uninfected and nonhospitalized. Methods We used a matched cohort design using inverse probability of treatment weight (IPTW). Individuals prescribed NMV/r within 3 days of COVID-19 diagnosis were compared with IPTW-based untreated controls. Variables for IPTW included age, race, sex, body mass index, geographic location, vaccination status, and multiple comorbidities. Additional analyses were conducted on NMV/r-treated and propensity score–matched untreated controls. Results Among 7615 individuals prescribed NMV/r and 62 077 controls identified between 1 January 2022 and 25 February 2023, the risk of hospitalization/death was lower among NMV/r-treated persons vs untreated controls (243 vs 3468 events; absolute risk difference [ARD], −2.36 [95% CI, −2.57 to −2.14]). The difference was significant for those >60 and ≤60 years old (ARD, −3.86 [95% CI, −4.19 to −3.54] vs −0.27 [95% CI, −0.51 to −0.03]) and for persons asymptomatic and symptomatic (ARD, −7.09 [95% CI, −7.62 to −6.55] vs −1.46 [95% CI, −1.66 to −1.25]). Significant benefit was observed among individuals unvaccinated and vaccinated, with or without a booster dose. Conclusions NMV/r is associated with a significant reduction in 30-day hospitalization or death among individuals previously uninfected and nonhospitalized. In a large national cohort, the risk of hospitalization/death was lower among nirmatrelvir/ritonavir-treated persons vs untreated controls. The difference was significant for individuals younger and older, symptomatic and asymptomatic, and vaccinated and unvaccinated.
ISSN:0022-1899
1537-6613
1537-6613
DOI:10.1093/infdis/jiad393