Oral Nirmatrelvir and Ritonavir in Nonhospitalized Vaccinated Patients With Coronavirus Disease 2019
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- Sarju Ganatra
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health , Burlington, Massachusetts , USA
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- Sourbha S Dani
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health , Burlington, Massachusetts , USA
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- Javaria Ahmad
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health , Burlington, Massachusetts , USA
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- Ashish Kumar
- Department of Medicine, Cleveland Clinic Akron General , Akron, Ohio , USA
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- Jui Shah
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health , Burlington, Massachusetts , USA
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- George M Abraham
- Division of Infectious Disease, Department of Medicine, Saint Vincent Hospital , Worcester, Massachusetts , USA
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- Daniel P McQuillen
- Division of Infectious Disease, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health , Burlington, Massachusetts , USA
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- Robert M Wachter
- Department of Medicine, University of California San Francisco , San Francisco, California , USA
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- Paul E Sax
- Division of Infectious Disease, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School , Boston, Massachusetts , USA
抄録
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Treatment of coronavirus disease 2019 (COVID-19) with nirmatrelvir plus ritonavir (NMV-r) in high-risk nonhospitalized unvaccinated patients reduced the risk of progression to severe disease. However, the potential benefits of NMV-r among vaccinated patients are unclear.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We conducted a comparative retrospective cohort study using the TriNetX research network. Patients ≥18 years of age who were vaccinated and subsequently developed COVID-19 between 1 December 2021 and 18 April 2022 were included. Cohorts were developed based on the use of NMV-r within 5 days of diagnosis. The primary composite outcome was all-cause emergency room (ER) visit, hospitalization, or death at a 30-day follow-up. Secondary outcomes included individual components of primary outcomes, multisystem symptoms, COVID-19–associated complications, and diagnostic test utilization.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>After propensity score matching, 1130 patients remained in each cohort. A primary composite outcome of all-cause ER visits, hospitalization, or death in 30 days occurred in 89 (7.87%) patients in the NMV-r cohort compared with 163 (14.4%) patients in the non–NMV-r cohort (odds ratio: .5; 95% confidence interval: .39–.67; P < .005) consistent with 45% relative risk reduction. A significant reduction in multisystem symptom burden and subsequent complications, such as lower respiratory tract infection, cardiac arrhythmia, and diagnostic radiology testing, were noted in NMV-r–treated patients. There was no apparent increase in serious complications between days 10 and 30.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Treatment with NMV-r in nonhospitalized vaccinated patients with COVID-19 was associated with a reduced likelihood of ER visits, hospitalization, or death. Complications and overall resource utilization were also decreased.</jats:p></jats:sec>
収録刊行物
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- Clinical Infectious Diseases
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Clinical Infectious Diseases 76 (4), 563-572, 2022-08-20
Oxford University Press (OUP)