Outcomes with and without outpatient SARS-CoV-2 treatment for patients with COVID-19 and systemic autoimmune rheumatic diseases: a retrospective cohort study

Qian, Grace; Wang, Xiaosong; Patel, Naomi J; Kawano, Yumeko; Fu, Xiaoqing; Cook, Claire; Vanni, Kathleen M M; Kowalski, Emily; Banasiak, Emily P; Bade, Katarina; Srivatsan, Shruthi; Williams, Zachary K.; Todd, Derrick J.; Weinblatt, Michael E.; Wallace, Zachary S; Sparks, Jeffrey A.

doi:10.1016/s2665-9913(23)00006-1

Cited by 28 publications

(65 citation statements)

References 33 publications

(46 reference statements)

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“…Thirteen studies reported mortality data, including 1,159,467 patients and 7,133 deaths (11,13–19,21–25). In comparison to standard treatment without antivirals, nirmatrelvir-ritonavir reduced the risk of death by 62% (OR= 0.38; 95% CI: 0.30-0.46; moderate certainty of evidence) (Fig 2).…”

Section: Resultsmentioning

confidence: 99%

“…The sixteen studies finally considered were conducted in 5 countries (Canada, China, United States, Israel, and United Kingdom). Of these, as of the last update of the search, 12 studies were published (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) and 4 were unpublished studies (preprint) (23)(24)(25)(26). All studies were retrospective cohorts of data obtained from electronic records of hospitals and other healthcare centers, collected from January 2021 to October 2022.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Effectiveness of Nirmatrelvir-Ritonavir for the treatment of patients with mild to moderate COVID-19 and at high risk of hospitalization: Systematic review and meta-analyses of observational studies

Souza

Carrasco²,

Rojas-Cortés

et al. 2023

Preprint

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Objective To assess the effectiveness of nirmatrelvir-ritonavir in the treatment of outpatients with mild to moderate COVID-19 who are at higher risk of developing severe illness, through a systematic review with meta-analyses of observational studies. Methods A systematic search was performed, in accordance with the Cochrane search methods, to identify observational studies that met the inclusion criteria. The outcomes of mortality and hospitalization were analyzed. Search was conducted on PubMed, EMBASE, and The Cochrane Library. Two reviewers independently screened references, selected the studies, extracted the data, assessed the risk of bias using ROBINS-I tool and evaluated the quality of evidence using the GRADE tool. This study followed the PRISMA reporting guideline. Results A total of 16 observational studies and 1,482,923 patients were finally included. The results of the meta-analysis showed that in comparison to standard treatment without antivirals, nirmatrelvir-ritonavir reduced the risk of death by 62% (OR= 0.38; 95% CI: 0.30-0.46; moderate certainty of evidence). In addition, a 53% reduction in the risk of hospital admission was observed (OR = 0.47; 95% CI: 0.36–0.60, with very low certainty of evidence). For the composite outcome of hospitalization and/or mortality, there was a 56% risk reduction (OR=0.44; 95% CI: 0.31-0.64, moderate certainty of evidence). Conclusion The results suggest that nirmatrelvir-ritonavir could be effective in reducing mortality and hospitalization. The results were valid in vaccinated or unvaccinated high-risk individuals with COVID-19. Data from ongoing and future trials may further advance our understanding of the effectiveness and safety of nirmatrelvir-ritonavir and help improve treatment guidelines for COVID-19.

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Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Effectiveness of Nirmatrelvir-Ritonavir for the treatment of patients with mild to moderate COVID-19 and at high risk of hospitalization: Systematic review and meta-analyses of observational studies

Souza

Carrasco²,

Rojas-Cortés

et al. 2023

Preprint

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“…When considering these impressive findings by Qian and colleagues, 2 we must acknowledge that associations reported in observational studies are not completely explained by causal relationships and are subject to confounding. The observed efficacy of antiviral or monoclonal antibody therapy reflects not only administration of the drug, but also the type of patient who is offered the drug.…”

mentioning

confidence: 97%

“…In The Lancet Rheumatology , Grace Qian and colleagues 2 report the findings of a retrospective cohort study that evaluated outpatient SARS-CoV-2 treatment with antivirals or monoclonal antibodies in 704 patients with systemic autoimmune rheumatic disease and COVID-19 (mean age 58·4 years [SD 15·9]; 536 [76%] were female and 168 [24%] were male, and 590 [84%] were White and 39 [6%] were Black). The authors compared the subsequent risk of hospitalisation or death (severe COVID-19 outcomes; within 30 days of the first positive test) in patients who received outpatient SARS-CoV-2 treatment versus those who received no outpatient treatment.…”

mentioning

confidence: 99%

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Real-world evidence for prehospital COVID-19 treatment in systemic autoimmune rheumatic disease

Bechman

Galloway

2023

The Lancet Rheumatology

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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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Outcomes with and without outpatient SARS-CoV-2 treatment for patients with COVID-19 and systemic autoimmune rheumatic diseases: a retrospective cohort study

Cited by 28 publications

References 33 publications

Effectiveness of Nirmatrelvir-Ritonavir for the treatment of patients with mild to moderate COVID-19 and at high risk of hospitalization: Systematic review and meta-analyses of observational studies

Effectiveness of Nirmatrelvir-Ritonavir for the treatment of patients with mild to moderate COVID-19 and at high risk of hospitalization: Systematic review and meta-analyses of observational studies

Real-world evidence for prehospital COVID-19 treatment in systemic autoimmune rheumatic disease

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

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