Real-World Effectiveness of Nirmatrelvir/Ritonavir on Coronavirus Disease 2019–Associated Hospitalization Prevention: A Population-based Cohort Study in the Province of Quebec, Canada-Reference-Cited by-同舟云学术

Real-World Effectiveness of Nirmatrelvir/Ritonavir on Coronavirus Disease 2019–Associated Hospitalization Prevention: A Population-based Cohort Study in the Province of Quebec, Canada

Published:2023-05-07 Issue:6 Volume:77 Page:805-815
ISSN:1058-4838
Container-title:Clinical Infectious Diseases
language:en
Short-container-title:

Author:

Kaboré Jean-Luc¹^ORCID,Laffont Benoît¹,Diop Mamadou¹,Tardif Melanie R¹,Turgeon Alexis F²³,Dumaresq Jeannot⁴⁵,Luong Me-Linh⁶,Cauchon Michel⁷,Chapdelaine Hugo⁸⁹,Claveau David¹⁰,Brosseau Marc¹¹¹²,Haddad Elie¹³,Benigeri Mike¹

Affiliation:

1. Institut National d’Excellence en Santé et Services Sociaux (INESSS) du Québec (Québec National Institute for Excellence in Health and Social Services) , Quebec City, Quebec , Canada

2. Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec—Université Laval Research Center , Quebec City, Quebec , Canada

3. Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval , Quebec City, Quebec , Canada

4. Department of Microbiology-Infectiology and Immunology, Faculty of Medicine, Université Laval , Quebec City, Quebec , Canada

5. Department of Microbiology and Infectious Diseases, Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches , Lévis, Quebec , Canada

6. Division of Infectious Diseases, Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM) , Montreal, Quebec , Canada

7. Department of Family Practice and Emergency, Université Laval , Quebec City, Quebec , Canada

8. Institut de Recherches Cliniques de Montréal, University of Montreal , Montreal, Quebec , Canada

9. Department of Medicine, Centre Hospitalier de l’Université de Montréal (CHUM), Centre de Recherches du CHUM , Montreal, Quebec , Canada

10. Departments of Emergency Medicine and Critical Care Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec, Centre Hospitalier Affilié Universitaire Régional , Trois-Rivières, Quebec , Canada

11. Department of Medicine, Pulmonary and Critical Care Medicine Divisions, Hôpital Maisonneuve-Rosemont, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal , Montreal, Quebec , Canada

12. Department of Medicine, Faculty of Medicine, Université de Montréal , Montreal, Quebec , Canada

13. Department of Pediatrics, University of Montreal, CHU Sainte-Justine , Montreal, Quebec , Canada

Abstract

Abstract Background Nirmatrelvir/ritonavir has shown to reduce COVID-19 hospitalization and death before Omicron, but updated real-world evidence studies are needed. This study aimed to assess whether nirmatrelvir/ritonavir reduces the risk of COVID-19–associated hospitalization among high-risk outpatients. Methods A retrospective cohort study of outpatients with SARS-CoV-2 between March 15 and 15 October 2022, using data from the Quebec clinico-administrative databases. Outpatients treated with nirmatrelvir/ritonavir were compared with infected ones not receiving nirmatrelvir/ritonavir using propensity-score matching. Relative risk (RR) of COVID-19–associated hospitalization within 30 days was assessed using a Poisson regression. Results A total of 8402 treated outpatients were matched to controls. Regardless of vaccination status, nirmatrelvir/ritonavir treatment was associated with a 69% reduced RR of hospitalization (RR: .31; 95% CI: .28; .36; number needed to treat [NNT] = 13). The effect was more pronounced in outpatients with incomplete primary vaccination (RR: .04; 95% CI: .03; .06; NNT = 8), while no benefit was found in those with a complete primary vaccination (RR: .93; 95% CI: .78; 1.08). Subgroups analysis among high-risk outpatients with a complete primary vaccination showed that nirmatrelvir/ritonavir treatment was associated with a significant decrease in the RR of hospitalization in severely immunocompromised outpatients (RR: .66; 95% CI: .50; .89; NNT = 16) and in high-risk outpatients aged ≥70 years (RR: .50; 95% CI: .34; .74; NNT = 10) when the last dose of the vaccine was received at least 6 months ago. Conclusions Nirmatrelvir/ritonavir reduces the risk of COVID-19–associated hospitalization among incompletely vaccinated high-risk outpatients and among some subgroups of completely vaccinated high-risk outpatients.

Funder

Institut National d’Excellence en Santé et en Services Sociaux

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

Link

https://academic.oup.com/cid/advance-article-pdf/doi/10.1093/cid/ciad287/50500617/ciad287.pdf

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