The landscape of development of treatment modalities and preventive measures for COVID-19 has progressed expeditiously since the beginning of the pandemic. However, low cost-effectiveness and availability, and the requirement of parenteral administration by trained medical personnel in an in-hospital setting may limit the use of these therapeutic agents in clinical practice. 1 Thus, the development of safe and efficacious oral agents that can be administered on an outpatient basis is warranted. On December 22, 2021, the US Food and Drug Administration (FDA) issued an emergency use authorization for an oral antiviral, nirmatrelvir-ritonavir (Paxlovid™), for the treatment of patients with mild-to-moderate COVID-19 and at high risk for progression to severe disease, including hospitalization or death. 2 Therefore, we conducted this meta-analysis to address these limitations and evaluate the efficacy and safety of nirmatrelvir-ritonavir in COVID-19 patients, and explore the role of previous immunity to SARS-CoV-2 and age as potential effect modifiers.Our meta-analysis was performed according to the guidelines of the Cochrane Handbook for Systematic Reviews of Intervention and the protocol was registered with PROSPERO (CRD42022364219). We searched PubMed, Embase, the Cochrane Library, medRxiv, and ClinicalTrials.gov from inception to October 10, 2022, using a search strategy consisting of terms related to "nirmatrelvir-ritonavir" and
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