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

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

Publication date: Feb 01, 2024

Nirmatrelvir-ritonavir (NR) was approved to treat SARS-CoV-2 positive outpatients at high risk of progression to severe disease, based on a randomized trial in unvaccinated patients. Effectiveness in vaccinated patients and against Omicron has not yet been confirmed by clinical trial data, but a recent meta-analysis suggested good real-world effectiveness based on 12 studies. We updated this meta-analysis by searching Medline and Embase databases for studies assessing effectiveness of NR on mortality, hospitalization, composite outcome of hospitalization and/or death, and progression to severe disease, published between October 1, 2022 and May 22, 2023. Random effects meta-analysis and subgroup analysis for vaccinated patients was performed. A total of 32 studies were included in the meta-analysis. Pooled RR for the effect of NR on mortality, hospitalization, hospitalization and/or mortality, and progression to severe disease were 0. 36 (95% confidence interval [CI]: 0. 25-0. 52), 0. 43 (CI: 0. 37-0. 51), 0. 52 (CI: 0. 45-0. 61) and 0. 54 (CI: 0. 41-0. 73), respectively. A subgroup analysis on vaccinated patients indicated lower effectiveness of NR on mortality (RR: 0. 55, CI: 0. 45-0. 68), but similar effectiveness for hospitalization, hospitalization and/or mortality, or progression to severe disease (RR: 0. 52, 0. 58, and 0. 66, respectively). This updated meta-analysis robustly confirms the protective effects of NR on severe COVID-19 outcomes.

Concepts Keywords
Covid Antiviral Agents
Databases Antiviral Agents
October COVID-19
Severe COVID-19
Vaccinated COVID-19 Drug Treatment
Humans
Lactams
Lactams
Leucine
Leucine
meta-analysis
nirmatrelvir
nirmatrelvir-ritonavir
Nitriles
Nitriles
Paxlovid
Proline
Proline
Ritonavir
Ritonavir
SARS-CoV-2
SARS-CoV-2
systematic review
Vaccination

Semantics

Type Source Name
disease VO effectiveness
drug DRUGBANK Ritonavir
disease MESH COVID-19
disease VO vaccination
disease VO unvaccinated
disease VO vaccinated
disease MESH death
drug DRUGBANK L-Leucine
drug DRUGBANK Proline

Original Article

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