Nirmatrelvir may be an effective agent to reduce COVID-19 associated hospitalization and death

1. Oral nirmatrelivir, started within 5 days of SARS0-CoV-2, reduces the risk of hospitalization and death at 30 days for individuals at risk for severe SARS0-CoV-2 illness. 

Evidence Rating Level: 2 (Good)

Nirmatrelivir, an antiviral agent given in combination with ritonavir, has been previously shown to reduce hospital admission or death at 28 days when given within 5 days of a SARS0-CoV-2 diagnosis to individuals at high risk for progression to severe illness. This data was previously collected from a randomized control trial published in 2022, prior to the spread of omicron, and did not include patients who had received any covid vaccines or were previously infected with SARS0-CoV-2 . The current study aimed to assess the effectiveness of starting oral nirmatrelivir versus no treatment within 5 days of a SARS0-CoV-2 positive result for reducing the risk of hospitalization or death at 30 days, accounting for vaccination status and previous SARS-CoV-2 infection. Researchers used healthcare databases from the US Department of Veteran Affairs to collect data on 256,288 participants who tested positive for SARS0-CoV-2 between January 3rd and November 30, 2022, with at least one risk factor for severe covid-19 illness, including age >60 years, body mass index >25, current smoking, chronic lung disease, cardiovascular disease, kidney disease, immune dysfunction, hypertension, diabetes, and cancer, and had not received any other covid treatments. Of this cohort, 31,524 individuals received nirmatrelivir within 5 days of diagnosis and 224,764 did not. Nirmatrelvir compared to no treatment was associated with a reduced risk of hospitalization or death, for unvaccinated individuals (RR 0.60, 0.5-0.71, absolute RR 1.83%, 1.29-2.49%), patients with 1-2 doses of a covid vaccine (RR 0.65, 0.57-0.74, absolute RR 1.27%, 0.90%-1.61%), a booster-dose of covid vaccine (RR 0.64, 0.58-0.71, absolute RR 1.05%, 0.85%-1.27%), first SARS-CoV-2 infection (RR 0.61, 0.57-0.65, absolute RR 1.36%, 1.19%-1.53%), and those who were re-infected with SARS-CoV-2 (RR 0.74, 0.63-0.87, and absolute RR 0.79%, 0.36%-1.18%). This demonstrates the effectiveness of nirmatevir for reducing the risk of hospitalization and death at 30 days for individuals at risk of severe SARS0-CoV-2, confirming that this medication is beneficial for those of varying vaccination status and previous SARS0-CoV-2 infections. Future research may re-assess the effectiveness of nirmatrelivir as further SARS0-CoV-2 variants emerge and with the distribution of future booster vaccines. 

Click to read the study in BMJ

Image: PD

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