口服抗病毒药物治疗非住院 COVID-19 合并慢性肾脏病患者的临床疗效。

Clinical effectiveness of oral antiviral agents for treating non-hospitalized COVID-19 patients with chronic kidney disease.

机构信息

Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.

Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.

出版信息

Expert Rev Anti Infect Ther. 2024 Aug;22(8):705-712. doi: 10.1080/14787210.2024.2334052. Epub 2024 Mar 26.

DOI:10.1080/14787210.2024.2334052

PMID:38525673

Abstract

OBJECTIVES

This study examined the effectiveness of nirmatrelvir plus ritonavir (NMV-r) and molnupiravir (MOV) in treating COVID-19 among chronic kidney disease (CKD) patients.

METHODS

This retrospective cohort study, using the TriNetX research network, identified stage 3-5 CKD and end-stage kidney disease (ESKD) patients with non-hospitalized COVID-19 between 1 January 2022, and 31 May 2023. Propensity score matching (PSM) was used to compare patients on NMV-r or MOV (antiviral group) against those not receiving these treatments (control group). The primary composite outcome was the cumulative hazard ratio (HR) for all-cause hospitalization or death within the 30-day follow-up.

RESULTS

After PSM, two balanced cohorts of 6,275 patients each were established. The antiviral group exhibited a lower incidence of all-cause hospitalization or mortality (5.93% vs. 9.53%; HR: 0.626; 95% CI: 0.550-0.713) than controls. Additionally, antiviral recipients were associated with a lower risk of all-cause hospitalization (HR: 0.679; 95% CI: 0.594-0.777) and mortality (HR: 0.338; 95% CI: 0.227-0.504). The beneficial effects of antiviral agents were consistent across sex, age, vaccination status, antiviral type, and CKD stage.

CONCLUSION

Oral antiviral agents could be associated with lower rates of all-cause hospitalization or death among non-hospitalized COVID-19 patients with CKD.

摘要

目的

本研究旨在评估奈玛特韦/利托那韦（NMV-r）和莫努匹韦（MOV）治疗慢性肾脏病（CKD）合并 COVID-19 患者的疗效。

方法

本回顾性队列研究利用 TriNetX 研究网络，纳入 2022 年 1 月 1 日至 2023 年 5 月 31 日期间非住院 COVID-19 合并 CKD 3-5 期和终末期肾病（ESKD）患者。采用倾向评分匹配（PSM）比较接受 NMV-r 或 MOV（抗病毒组）与未接受这些治疗的患者（对照组）。主要复合结局为 30 天随访内全因住院或死亡的累积风险比（HR）。

结果

PSM 后，建立了两组各 6275 例平衡的队列。抗病毒组全因住院或死亡发生率较低（5.93% vs. 9.53%；HR：0.626；95%CI：0.550-0.713）。此外，抗病毒组全因住院（HR：0.679；95%CI：0.594-0.777）和死亡（HR：0.338；95%CI：0.227-0.504）风险均较低。抗病毒药物的获益在性别、年龄、疫苗接种状态、抗病毒药物类型和 CKD 分期中均一致。