Annals of Medicine (Dec 2024)

Associations of nirmatrelvir-ritonavir treatment with death and clinical improvement in hospitalized patients with COVID-19 during the Omicron wave in Beijing, China: a multicentre, retrospective cohort study

  • Xiaobo Han,
  • Chenglong Li,
  • Xin Yuan,
  • Junchang Cui,
  • Zhihai Han,
  • Jiguang Meng,
  • Weiguo Zhao,
  • Fei Xie,
  • Kaifei Wang,
  • Yuhong Liu,
  • Guoxin Muo,
  • Na Xi,
  • Mengli Zheng,
  • Rentao Wang,
  • Kun Xiao,
  • Wei Chen,
  • Junchen Xiong,
  • Dahui Zhao,
  • Xinxin Zhang,
  • Xinjie Han,
  • Haibo Cheng,
  • Zhongkuo Yu,
  • Yinghan Shi,
  • Wuxiang Xie,
  • Lixin Xie

DOI
https://doi.org/10.1080/07853890.2024.2313062
Journal volume & issue
Vol. 56, no. 1

Abstract

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AbstractBackground The effectiveness of nirmatrelvir–ritonavir has mainly been shown in non-hospitalized patients with mild-to-moderate coronavirus disease 2019 (COVID-19). The real-world effectiveness of nirmatrelvir-ritonavir urgently needs to be determined using representative in-hospital patients with COVID-19 during the Omicron wave of the pandemic.Methods We performed a multicentre, retrospective study in five Chinese PLA General Hospital medical centers in Beijing, China. Patients hospitalized with COVID-19 from 10 December 2022 to 20 February 2023 were eligible for inclusion. A 1:1 propensity score matching was performed between the nirmatrelvir-ritonavir group and the control group.Results 1010 recipients of nirmatrelvir-ritonavir and 1010 matched controls were finally analyzed after matching. Compared with matched controls, the nirmatrelvir-ritonavir group had a lower incidence rate of all-cause death (4.6/1000 vs. 6.3/1000 person-days, p = 0.013) and a higher incidence rate of clinical improvement (47.6/1000 vs. 45.8/1000 person-days, p = 0.012). Nirmatrelvir-ritonavir was associated with a 22% lower all-cause mortality and a 14% higher incidence of clinical improvement. Initiation of nirmatrelvir-ritonavir within 5 days after symptom onset was associated with a 50% lower mortality and a 26% higher clinical improvement rate. By contrast, no significant associations were identified among patients receiving nirmatrelvir-ritonavir treatment more than 5 days after symptom onset. Nirmatrelvir-ritonavir was also associated with a 50% increase in survival days and a 12% decrease in days to clinical improvement.Conclusion Among hospitalized patients with COVID-19 during the Omicron wave in Beijing, China, the early initiation of nirmatrelvir-ritonavir was associated with clinical benefits of lowering mortality and improving clinical recovery.

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