Department of Pharmacy, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
Institute of Clinical Pharmacy, Central South University, Changsha, Hunan, China.
J Glob Health. 2023 Jul 21;13:06032. doi: 10.7189/jogh.13.06032.
The efficacy of nirmatrelvir plus ritonavir (NMV-r) for vaccinated COVID-19 patients at high risk of progression is not adequately recognised. To address this gap, we conducted a systematic review and meta-analysis of current literature.
We searched PubMed, Web of Science, Embase, Cochrane Library, and medRxiv for articles published up to 8 January 2023 on NMV-r in outpatients. At least two researchers screened articles, extracted data, and assessed the quality of selected studies. We evaluated the results via risk ratios (RRs) with 95% confidence intervals (CIs) and tested for heterogeneity using I statistics.
We included seven observational cohort studies comprising 224 238 vaccinated patients. According to our meta-analysis, NMV-r reduced 47% incidence of all-cause death or hospitalisation within 30 days for vaccinated patients (RR = 0.53; 95% CI = 0.40-0.70; I = 81%). After excluding the most influential result by sensitivity analysis, NMV-r still reduced risk of all-cause death or hospitalisation by 38% (RR = 0.62; 95% CI = 0.56-0.69; I = 0%). In our secondary outcome, NMV-r also showed its benefits in reducing all-cause death in vaccinated patients (RR = 0.40; 95% CI = 0.19-0.85; I = 23%).
We found positive evidence for the use of NMV-r for vaccinated patients at high-risk of progression with mild to moderate COVID-19. However, large-scale RCTs are needed to confirm these findings.
PROSPERO CRD42023391349.
尼马曲韦（nirmatrelvir）加利托那韦（ritonavir，NMV-r）对于有进展高风险的接种 COVID-19 疫苗患者的疗效尚未得到充分认识。为了弥补这一空白，我们对当前文献进行了系统回顾和荟萃分析。
我们在 PubMed、Web of Science、Embase、Cochrane Library 和 medRxiv 中检索截至 2023 年 1 月 8 日发表的门诊使用 NMV-r 的文章。至少有两名研究人员筛选文章、提取数据并评估入选研究的质量。我们通过风险比（RR）及其 95%置信区间（CI）评估结果，并使用 I ² 统计量检验异质性。
我们纳入了 7 项观察性队列研究，共纳入 224238 例接种疫苗的患者。我们的荟萃分析显示，NMV-r 降低了 30 天内所有原因死亡或住院的发生率，接种疫苗患者的风险降低 47%（RR=0.53；95%CI=0.40-0.70；I²=81%）。在敏感性分析排除最有影响的结果后，NMV-r 仍能降低 38%的所有原因死亡或住院风险（RR=0.62；95%CI=0.56-0.69；I²=0%）。在次要结局中，NMV-r 也显示出降低接种疫苗患者全因死亡率的益处（RR=0.40；95%CI=0.19-0.85；I²=23%）。
我们发现，对于有进展高风险的轻至中度 COVID-19 接种疫苗患者，使用 NMV-r 有积极证据。然而，需要进行大规模 RCT 来证实这些发现。
PROSPERO CRD42023391349。
