Nirmatrelvir/ritonavir and remdesivir against symptomatic treatment in high-risk COVID-19 outpatients to prevent hospitalization or death during the Omicron era: a propensity score-matched study

Author:

Rajme-López Sandra1ORCID,Martinez-Guerra Bernardo A.1,Román-Montes Carla M.1,Tamez-Torres Karla M.1,Tello-Mercado Andrea C.1,Tepo-Ponce Karen M.1,Segura-Ortíz Zurisadai1,López-Aguirre Abigail1,Gutiérrez-Mazariegos Orianlid del Rocío1,Lazcano-Delgadillo Oswaldo1,Nares-López Rafael1,González-Lara María F.1,Kershenobich-Stalnikowitz David2,Sifuentes-Osornio José2,Ponce-de-León Alfredo1,Ruíz-Palacios Guillermo M.3

Affiliation:

1. Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición ‘Salvador Zubirán’, Mexico City, Mexico

2. Instituto Nacional de Ciencias Médicas y Nutrición ‘Salvador Zubirán’, Mexico City, Mexico

3. Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición ‘Salvador Zubirán’, Vasco de Quiroga #15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de México 14080, México

Abstract

Background: Even though worldwide death rates from coronavirus disease 2019 (COVID-19) have decreased, the threat of disease progression and death for high-risk groups continues. Few direct comparisons between the available severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antivirals have been made. Objective: We aimed to compare two SARS-CoV-2 antivirals (nirmatrelvir/ritonavir and remdesivir) against all-cause hospitalization or death. Design: This is a propensity score-matched cohort study. Methods: We included all high-risk outpatients with COVID-19 in a tertiary referral center in Mexico City from 1 January 2022 to 31 July 2023. The primary outcome was all-cause hospitalization or death 28 days after symptom onset. The secondary outcome was COVID-19-associated hospitalization or death 28 days after symptom onset. Logistic regression analysis for characteristics associated with the primary outcome and a multi-group comparison with Kaplan–Meier survival estimates were performed. Results: Of 1566 patients analyzed, 783 did not receive antiviral treatment, 451 received remdesivir, and 332 received nirmatrelvir/ritonavir. The median age was 60 years (interquartile range: 46–72), 62.5% were female and 97.8% had at least one comorbidity. The use of nirmatrelvir/ritonavir was associated with an absolute risk reduction of 8.8% and a relative risk reduction of 90% for all-cause hospitalization or death. The use of remdesivir was associated with an absolute risk reduction of 6.4% and a relative risk reduction of 66% for all-cause hospitalization or death. In multivariable analysis, both antivirals reduced the odds of 28-day all-cause hospitalization or death [nirmatrelvir/ritonavir odds ratio (OR) 0.08 – 95% confidence interval (CI): 0.03–0.19, remdesivir OR 0.29 – 95% CI: 0.18–0.45]. Conclusion: In high-risk COVID-19 outpatients, early antiviral treatment with nirmatrelvir/ritonavir or remdesivir was associated with lower 28-day all-cause hospitalization or death.

Publisher

SAGE Publications

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