Rudolph Abby E, Khan Farid L, Singh Tanya G, Valluri Srinivas Rao, Puzniak Laura A, McLaughlin John M
Pfizer Vaccines, 500 Arcola Rd, Collegeville, PA, 19426, USA.
Walgreens Co., Deerfield, IL, USA.
Infect Dis Ther. 2024 Sep;13(9):2035-2052. doi: 10.1007/s40121-024-01023-z. Epub 2024 Aug 3.
Although real-world studies demonstrate that those prescribed nirmatrelvir/ritonavir (and particularly within 5 days of symptom onset) are less likely to experience severe COVID-19 outcomes, prior studies show that only a small fraction of patients with COVID-19 who are eligible for nirmatrelvir/ritonavir receive a prescription. Studies calculating the proportion of nirmatrelvir/ritonavir prescriptions filled and identifying individual- and pharmacy-level correlates of filling nirmatrelvir/ritonavir are lacking.
This retrospective cohort study included individuals aged ≥ 12 years with a nirmatrelvir/ritonavir prescription ordered at a large national retail pharmacy (December 22, 2021-August 12, 2023). Those taking contraindicated medications were excluded. For those with only one nirmatrelvir/ritonavir prescription ordered, the outcome was whether the prescription was filled (yes/no). In a subanalysis of these individuals, the outcome was whether the prescription was filled within 5 days of symptom onset (yes/no). For those with multiple prescriptions ordered, the outcome was whether > 1 (vs. 0 or 1) prescriptions were filled. A log-binomial regression with generalized estimating equations was used to identify individual (clinical and demographic) and pharmacy-level (percentage of trade area that is non-Hispanic white, urbanicity, US Census region, and tract-level area deprivation index) correlates.
A total of 2,103,570 unique nirmatrelvir/ritonavir prescriptions were ordered for 1,985,990 individuals. Among the 95% of individuals prescribed only one nirmatrelvir/ritonavir course, 88% filled their prescription. Among those with > 1 prescription ordered, 77% (82,993/108,411) filled one and 13% (13,662/108,411) filled > 1. Patients ≥ 50 years of age and those with documented high-risk conditions were slightly more likely to fill prescriptions, regardless of whether one or multiple courses were ordered. Individuals with cancer, asthma, or taking corticosteroids or immunosuppressive medications were more likely to fill multiple prescriptions.
Most patients filled their nirmatrelvir/ritonavir prescriptions. Interventions to improve uptake should focus on increasing patient and provider awareness, reducing nirmatrelvir/ritonavir prescribing disparities, and ensuring treatment initiation within 5 days.
尽管现实世界的研究表明，服用奈玛特韦/利托那韦的患者（尤其是在症状出现后5天内服药的患者）发生重症COVID-19结局的可能性较低，但先前的研究表明，符合奈玛特韦/利托那韦治疗条件的COVID-19患者中，只有一小部分获得了处方。目前缺乏关于计算奈玛特韦/利托那韦处方配药比例以及确定影响奈玛特韦/利托那韦配药的个体和药房层面相关因素的研究。
这项回顾性队列研究纳入了年龄≥12岁、在一家大型全国零售药房订购了奈玛特韦/利托那韦处方的患者（2021年12月22日至2023年8月12日）。服用禁忌药物的患者被排除。对于仅订购了一剂奈玛特韦/利托那韦处方的患者，结局指标是该处方是否被配药（是/否）。在对这些个体的亚分析中，结局指标是处方是否在症状出现后5天内被配药（是/否）。对于订购了多剂处方的患者，结局指标是是否有超过1剂（与0剂或1剂相比）处方被配药。使用带有广义估计方程的对数二项回归来确定个体（临床和人口统计学）和药房层面（非西班牙裔白人在贸易区的比例、城市化程度、美国人口普查区域以及地段层面的地区贫困指数）的相关因素。
共为1,985,990名个体订购了2,103,570剂独特的奈玛特韦/利托那韦处方。在仅开具一剂奈玛特韦/利托那韦疗程的患者中，95%的患者中，88%配到了药。在订购了超过1剂处方的患者中，77%（82,993/108,411）配到了1剂，13%（13,662/108,411）配到了超过1剂。无论订购的是一剂还是多剂疗程，年龄≥50岁的患者以及有记录的高危疾病患者配药的可能性略高。患有癌症、哮喘或正在服用皮质类固醇或免疫抑制药物的个体更有可能配到多剂处方。
大多数患者配到了他们的奈玛特韦/利托那韦处方。旨在提高药物获取率的干预措施应侧重于提高患者和医疗服务提供者的意识、减少奈玛特韦/利托那韦处方开具方面的差异，并确保在5天内开始治疗。
