Impact of the Use of Oral Antiviral Agents on the Risk of Hospitalisation in Community COVID-19 Patients

Yip, Cheuk Fung; Lui, Grace Chung‐Yan; Lai, Mandy Sze Man; Wong, Vincent Wai‐Sun; Tse, Yee‐Kit; Hon-Ming, Bosco; Hui, Elsie; Leung, Maria KW; Chan, Henry Lik‐Yuen; Hui, David Shu-Cheong

doi:10.2139/ssrn.4112160

Cited by 4 publications

(1 citation statement)

References 13 publications

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“…Nirmatrelvir is an antiviral agent targeting the SARS‐CoV‐2 3‐chymotrypsin‐like cysteine protease enzyme, while ritonavir is a CYP3A4 inhibitor and combines with nirmatrelvir to enhance nirmatrelvir pharmacokinetics 10 . Several studies 6–8,11 have suggested that Paxlovid might be effective in COVID‐19 patients in terms of reducing mortality and hospitalization rate. However, no comprehensive meta‐analysis has been reported on the use of Paxlovid in the management of patients infected with SARS‑CoV‑2.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of nirmatrelvir/ritonavir (Paxlovid) for COVID‐19: A rapid review and meta‐analysis

Amani

2023

Journal of Medical Virology

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This study aimed to examine the efficacy and safety of nirmatrelvir/ritonavir (Paxlovid) for coronavirus disease 2019 (COVID‐19). PubMed, Cochrane Library, Web of Science, medRxiv, and Google Scholar were searched to identify the relevant evidence up to November 10, 2022. The reference lists of key studies were also scanned to find additional records. The quality of the studies was evaluated using the Cochrane tools for assessing the risk of bias. The Comprehensive Meta‐Analysis software version 3.0 was employed for data analysis. Twenty‐three studies involving 314 353 patients were included in the analysis. The findings of the meta‐analysis showed a significant difference between the Paxlovid and no‐Paxlovid groups in terms of mortality rate (odds ratio [OR] = 0.25; 95% confidence interval [CI]: 0.14–0.45), hospitalization rate (OR = 0.40; 95% CI: 0.24–0.69), polymerase chain reaction negative conversion time (mean difference [MD] = −2.46; 95% CI: −4.31 to −0.61), and hospitalization or death rate (OR = 0.17; 95% CI: 0.06–0.46). However, no significant difference was observed between the two groups in terms of COVID‐19 rebound (OR = 0.84; 95% CI: 0.67–1.04), emergency department visit (OR = 0.75; 95% CI: 0.45–1.24), intensive care unit admission (OR = 0.37; 95% CI: 0.13–1.01), and adverse events (OR = 2.20; 95% CI: 0.42–11.47). The results of the present study support the efficacy and safety of Paxlovid in the treatment of patients with COVID‐19. Further research is needed to investigate the COVID‐19 rebound after Paxlovid treatment.

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Section: Introductionmentioning

confidence: 99%

Efficacy and safety of nirmatrelvir/ritonavir (Paxlovid) for COVID‐19: A rapid review and meta‐analysis

Amani

2023

Journal of Medical Virology

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Determining population-level allocation strategies for COVID-19 treatments in the United States using a quantitative framework, a case study using nirmatrelvir/ritonavir

Savinkina

Gonsalves

Ross

et al. 2022

Preprint

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Background: New COVID-19 medications force decision makers to weigh limited evidence of efficacy and cost in determining which patient populations to target for treatment. A case in point is nirmatrelvir/ritonavir, a drug that has been recommended for elderly, high-risk individuals, regardless of vaccination status, even though clinical trials have only evaluated it in unvaccinated patients. A simple optimization framework might inform a more reasoned approach to the tradeoffs implicit in the treatment allocation decision. Methods: We used a mathematical model to analyze the cost-effectiveness of four nirmatrelvir/ritonavir allocation strategies, stratified by vaccination status and risk for severe disease. We considered treatment effectiveness at preventing hospitalization ranging from 21% to 89%. Sensitivity analyses were performed on major parameters of interest. A web-based tool was developed to permit decision-makers to tailor the analysis to their settings and priorities. Results: Providing nirmatrelvir/ritonavir to unvaccinated patients at high-risk for severe disease was cost-saving when effectiveness against hospitalization exceeded 33% and cost-effective under all other data scenarios we considered. The cost-effectiveness of other allocation strategies, including those for vaccinated adults and those at lower-risk for severe disease, depended on willingness-to-pay thresholds, treatment cost and effectiveness, and the likelihood of severe disease. Conclusions: Priority for nirmatrelvir/ritonavir treatment should be given to unvaccinated persons at high-risk of severe disease from COVID-19. Further priority may be assigned by weighing treatment effectiveness, disease severity, drug cost, and willingness to pay for deaths averted.

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Real-Life Experience of Molnupiravir in Hospitalized Patients Who Developed SARS-CoV2-Infection: Preliminary Results from CORACLE Registry

et al. 2022

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Real-life experience of molnupiravir treatment is lacking, especially in people hospitalized for underlying diseases not related to COVID-19. We conducted a retrospective analysis regarding molnupiravir therapy in patients with SARS-CoV-2 infection admitted for underlying diseases not associated with COVID-19. Forty-four patients were included. The median age was 79 years (interquartile range [IQR]: 51–93 years), and most males were 57,4%. The median Charlson Comorbidity Index and 4C score were, respectively, 5 (IQR: 3–10) and 9.9 (IQR: 4–12). Moreover, 77.5% of the patients had at least two doses of the anti-SARS-CoV-2 vaccine, although 10.6% had not received any SARS-CoV-2 vaccine. Frequent comorbidities were cardiovascular diseases (68.1%), and diabetes (31.9%), and most admissions were for the acute chronic heart (20.4%) or liver (8.5%) failure. After molnupiravir started, 8 (18.1%) patients developed acute respiratory failure, and five (11.4%) patients died during hospitalisation. Moreover, molnupiravir treatment does not result in a statistically significant change in laboratory markers except for an increase in the monocyte count (p = 0.048, Z = 1.978). Molnupiravir treatment in our analysis was safe and well tolerated. In addition, no patients’ characteristics were found significantly related to hospital mortality or an increase in oxygen support. The efficacy of the molecule remains controversial in large clinical studies, and further studies, including larger populations, are required to fill the gap in this issue.

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Impact of the Use of Oral Antiviral Agents on the Risk of Hospitalisation in Community COVID-19 Patients

Cited by 4 publications

References 13 publications

Efficacy and safety of nirmatrelvir/ritonavir (Paxlovid) for COVID‐19: A rapid review and meta‐analysis

Efficacy and safety of nirmatrelvir/ritonavir (Paxlovid) for COVID‐19: A rapid review and meta‐analysis

Determining population-level allocation strategies for COVID-19 treatments in the United States using a quantitative framework, a case study using nirmatrelvir/ritonavir

Real-Life Experience of Molnupiravir in Hospitalized Patients Who Developed SARS-CoV2-Infection: Preliminary Results from CORACLE Registry

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