The Antiviral Effect of Nirmatrelvir/Ritonavir during COVID-19 Pandemic Real-World Data

Abstract

Introduction: Vaccination against SARS-CoV-2 and the prevalence of Omicron variants have reduced the risk of the severe clinical progress of COVID-19. However, the risk of breakthrough infections has increased, and early administration of an effective antiviral treatment is significant in order to prevent the severe progression of COVID-19 in vulnerable patients with comorbidities. Patients and methods: Adults with confirmed SARS-CoV-2 infection were included in a matched-pair retrospective study based on age, gender, comorbidities and vaccination status. They were divided into two groups: group A (n = 200) consisted of outpatients at increased risk of severe clinical progress who were treated with nirmatrelvir/ritonavir and group B (n = 200) consisted of non-hospitalized patients who did not receive antiviral treatment. Demographic data, clinical outcome (death, intubation), days of hospitalization, time for recovery, adverse events and treatment compliance were reported. Results: The median age (75.24 ± 13.12 years in the study group and 76.91 ± 14.02 years in the comparison group) and the proportion of males (59% vs. 60.5%, respectively) were similar between the two groups. A total of 6.5% of patients in group A and 10.5% in group B were unvaccinated against SARS-CoV-2. Three patients from group A (1.5%) and one hundred eleven (55.5%) from group B required hospitalization. The duration of hospitalization (3 days vs. 10 days in group B, p < 0.001) and the total time needed for recovery (5 days vs. 9 days, p < 0.001) was shorter in the study group. A rebound of SARS-CoV-2 infection within 8–12 days after diagnosis was documented in 6.5% of patients in group A and 8% of patients in group B. Conclusion: Oral treatment with nirmatrelvir/ritonavir in high-risk non-hospitalized patients was safe and effective in preventing the severe clinical progress of COVID-19 pneumonia. Early administration of antiviral agents in vulnerable outpatients combined with a full vaccination scheme is significant in order to avoid hospitalization and severe clinical outcomes.

Effectiveness of Oral Nirmatrelvir/Ritonavir vs. Intravenous Three-Day Remdesivir in Preventing Progression to Severe COVID-19: A Single-Center, Prospective, Comparative, Real-Life Study

“…In our study, we had no treatment discontinuations due to side effects for both treatment arms. We did not record minor adverse events, not dictating treatment discontinuation, but regulatory studies showed that both remdesivir and NMV/r seem to be well tolerated, with low rates of treatment discontinuation [ 31 , 32 ].…”

“…Mazzitelli et al, in Italy, compared 3RDV to no treatment in a large real-world cohort and found that the use of 3RDV would reduce the risk of hospitalization by 95% and the duration of positivity and symptoms by eight and five days, respectively [ 39 ]. Similarly, a recent observational study from Greece compared NMV/r to no treatment and showed that in the first group, only 1.5% required eventual hospitalization, compared to a staggering 55.5% in the control group [ 32 ].…”

Adherence and recommended optimal treatment to Azvudine application for the treatment of outpatient COVID-19 patients: A real-world retrospective study

“…Healthcare providers should educate patients on the correct dosage and duration of Azvudine. Compared to other effective antiviral drugs, such as Paxlovid, the Greek study found that compliance was 97.5 %, which was attributed to patients voluntarily stopping treatment two or three days after starting treatment due to significant clinical improvement (doctors recommended 5 days of treatment) [ 15 ].…”

Effectiveness of nirmatrelvir‐ritonavir on severe outcomes of COVID‐19 in the era of vaccination and Omicron: An updated meta‐analysis

“…The most heterogeneous results were observed for disease progression, with some studies reporting a statistically significant protective effect of NR, while other studies T A B L E 2 Comparison of the pooled risk ratios (RR) for the different outcomes, including sensitivity analyses and subgroup analysis. Included studies were 34,38,40,41,43,46,47,50,[52][53][54]58,[62][63][64][65][66] observed (nonsignificant) higher risk of progression with administration of NR.…”