Division of Health Policy and Public Health, Department of Emergency Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Department of Medicine, Cleveland Clinic Akron General, Akron, Ohio, USA.
Clin Infect Dis. 2023 Nov 11;77(9):1257-1264. doi: 10.1093/cid/ciad400.
The effects of nirmatrelvir/ritonavir (NMV/r [Paxlovid]) on coronavirus disease 2019 (COVID-19) outcomes in younger vaccinated adults are unclear. The objective of this study was to assess if NMV/r use in vaccinated adults aged ≤50 years is associated with improved outcomes and to identify beneficial and nonbeneficial subgroups.
In this cohort study, we generated 2 propensity-matched cohorts of 2547 patients from an 86 119-person cohort assembled from the TriNetX database. Patients in 1 cohort received NMV/r, and patients in the matched control cohort did not. The main outcome was composite of all-cause emergency department visits, hospitalization, and mortality.
The composite outcome was detected in 4.9% of the NMV/r cohort and 7.0% of the non-NMV/r cohort (odds ratio, 0.683 [95% confidence interval, .540-.864]; P = .001), indicating a 30% relative risk reduction. The number needed to treat (NNT) for the primary outcome was 47. Subgroup analyses found significant associations for patients with cancer (NNT = 45), cardiovascular disease (NNT = 30), and both conditions (NNT = 16). No benefit was found for patients with only chronic lower respiratory disorders (asthma/chronic obstructive pulmonary disease [COPD]) or without serious comorbidities. Thirty-two percent of NMV/r prescriptions in the overall database were for 18- to 50-year-olds.
NMV/r use in vaccinated adults aged 18-50 years, especially with serious comorbidities, was associated with reduced all-cause hospital visits, hospitalization, and mortality in the first 30 days of COVID-19 illness. However, NMV/r in patients without significant comorbidities or with only asthma/COPD had no association of benefit. Therefore, identifying high-risk patients should be a priority and overprescription should be avoided.
尼马瑞韦/利托那韦（NMV/r[帕罗韦德]）对年轻接种疫苗成年人 2019 年冠状病毒病（COVID-19）结局的影响尚不清楚。本研究的目的是评估在≤50 岁的接种疫苗成年人中使用 NMV/r 是否与改善结局相关，并确定有益和无益亚组。
在这项队列研究中，我们从 TriNetX 数据库中 86119 人的队列中生成了 2547 名患者的 2 个倾向评分匹配队列。一组患者接受了 NMV/r，而匹配的对照组患者未接受 NMV/r。主要结局是所有原因急诊就诊、住院和死亡的复合结局。
NMV/r 队列中复合结局的发生率为 4.9%，而非 NMV/r 队列中为 7.0%（比值比，0.683[95%置信区间，0.540-0.864]；P=0.001），表明相对风险降低了 30%。治疗效果为阳性的患者数（NNT）为 47。亚组分析发现，患有癌症（NNT=45）、心血管疾病（NNT=30）和同时患有这两种疾病（NNT=16）的患者存在显著关联。对于仅患有慢性下呼吸道疾病（哮喘/慢性阻塞性肺疾病[COPD]）或无严重合并症的患者，未发现获益。在整个数据库中，NMV/r 的处方有 32%用于 18 至 50 岁的患者。
在 COVID-19 发病的前 30 天内，18 至 50 岁的接种疫苗成年人使用 NMV/r，尤其是患有严重合并症的成年人，与降低全因就诊、住院和死亡率相关。然而，NMV/r 在无明显合并症或仅患有哮喘/COPD 的患者中与获益无关。因此，应优先确定高危患者并避免过度处方。
