Appraisal of evidence reliability and applicability of Paxlovid as treatment for SARS‐COV‐2 infection: A systematic review

Abstract

AbstractThis study aimed to clarify the beneficial effect and the clinical application value of Paxlovid in the treatment of coronavirus disease‐19 (COVID‐19) through a systematic review. Databases including PubMed, Cochrane Library, Chinese Clinical Trial Registry, and ClinicalTrials.gov were systematically searched for interventional or observational studies on the efficacy and safety of Paxlovid in the treatment of SARS‐COV‐2. The relative and absolute effect sizes for the outcomes were calculated based on the data reported in the original intervention literature. The external applicability of the evidence was analysed in terms of clinical application scenarios, patient willingness, and cost utility. One interventional and three observational studies were conducted. Four studies published in 2022, had participation sample sizes ranging 1780–109,254. Based on the randomised controlled trial data, the risk of all‐cause mortality, all‐cause death, and hospitalisation was significantly reduced in the Paxlovid group. Serious adverse events were reduced during the study. Based on observational studies, Paxlovid can significantly reduce the risk of death and hospitalisation in older patients with COVID‐19 (moderate certainty) and improve in‐hospital disease progression, composite disease progression, and viral load (low certainty). Paxlovid did not improve the outcomes of death and hospitalisation (low certainty) in patients aged <65 years. As per the economic utility analysis, the economic cost of reducing one death dramatically decreased with increasing age. Early use of Paxlovid in the older adult population with COVID‐19 is beneficial. However, in the setting of limited resources, Paxlovid should be prioritised for older patients.