Nirmatrelvir–ritonavir for the treatment of COVID‐19 patients: A systematic review and meta‐analysis

Abstract

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

Real-world effectiveness of Azvudine in hospitalized patients with COVID-19: a retrospective cohort study

“…In contrast, treatment with Azvudine was not signi cantly associated with intensive care unit admission and high-ow oxygen therapy. Nirmatrelvir-ritonavir has been reported to reduce severe COVID-19 and mortality in high-risk patients in clinical trials and real-world studies [10][11][12] . Nevertheless, the clinical effectiveness of Azvudine in real-world studies is lacking, despite the clinical trials showed shorter time of nucleic acid negative conversion.…”

Real‐world effectiveness of Azvudine versus nirmatrelvir–ritonavir in hospitalized patients with COVID‐19: A retrospective cohort study

“…Current guidelines prioritize the use of nirmatrelvir–ritonavir and Azvudine in COVID‐19 patients 2–4 . Nevertheless, the real‐world effectiveness of Azvudine versus nirmatrelvir–ritonavir is still lacking, despite clinical studies showing their effectiveness compared with matched controls 9–11,13,14 …”

“…In a phase III study, nirmatrelvir–ritonavir was reported to reduce the rates of hospitalization and mortality by 88% when the drug was initiated within 5 days of symptom onset in high‐risk patients 8 . Further studies have also arrived at a consistent conclusion that nirmatrelvir–ritonavir significantly reduces severe COVID‐19 and mortality 9–11 . Thus, the current guidelines prioritize the use of nirmatrelvir–ritonavir in COVID‐19 patients within 5 days of symptom onset 2–4 .…”

Real-world effectiveness of Azvudine in hospitalized patients with COVID-19: a retrospective cohort study

“…At the beginning of the change in COVID-19 prevention and control measures in December 2022 1 , two oral antiviral drugs were approved and recommended to treat the COVID-19 patients in the Diagnosis and Treatment Program for Novel Coronavirus Pneumonia including nirmatrelvir-ritonavir and Azvudine [7][8][9] . Nirmatrelvir-ritonavir has been reported to reduce severe COVID-19 and mortality in high-risk patients in clinical trials and real-world studies [10][11][12] . Nevertheless, the clinical effectiveness of Azvudine in real-world studies is lacking, despite the clinical trials showed shorter time of nucleic acid negative conversion.…”