{"id":23675,"date":"2023-04-08T04:31:00","date_gmt":"2023-04-07T20:31:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=23675"},"modified":"2023-04-09T16:06:36","modified_gmt":"2023-04-09T08:06:36","slug":"lancet-infect-dis%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e7%be%8e%e5%9b%bd%e7%a7%91%e7%bd%97%e6%8b%89%e5%a4%9a%e5%b7%9e%e5%a5%a5%e5%af%86%e5%85%8b%e6%88%8e%e5%8f%98%e5%bc%82%e6%a0%aa%e6%b5%81","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=23675","title":{"rendered":"[Lancet Infect Dis\u53d1\u8868\u8bba\u6587]\uff1a\u7f8e\u56fd\u79d1\u7f57\u62c9\u591a\u5ddeBA.4\u548cBA.5\u5965\u5bc6\u514b\u620e\u53d8\u5f02\u682a\u6d41\u884c\u671f\u95f4\u65b0\u51a0\u75c5\u6bd2\u611f\u67d3\u95e8\u8bca\u60a3\u8005\u4f7f\u7528\u5948\u739b\u7279\u97e6-\u5229\u6258\u90a3\u97e6"},"content":{"rendered":"\n

ARTICLES|ONLINE FIRST<\/a><\/p>\n\n\n\n

Real-world use of nirmatrelvir\u2013ritonavir in outpatients with COVID-19 during the era of omicron variants including BA.4 and BA.5 in Colorado, USA: a retrospective cohort study<\/h1>\n\n\n\n

Neil R Aggarwal, Kyle C Molina, Laurel E Beaty, et al.<\/h3>\n\n\n\n

Lancet Infect Dis Published: February 10, 2023<\/h3>\n\n\n\n

DOI:https:\/\/doi.org\/10.1016\/S1473-3099(23)00011-7<\/a><\/h3>\n\n\n\n

Summary<\/h2>\n\n\n\n

Background<\/h3>\n\n\n\n

Nirmatrelvir is a protease inhibitor with in-vitro activity against SARS-CoV-2, and ritonavir-boosted nirmatrelvir can reduce the risk of progression to severe COVID-19 among individuals at high risk infected with delta and early omicron variants. However, less is known about the effectiveness of nirmatrelvir\u2013ritonavir during more recent BA.2, BA2.12.1, BA.4, and BA.5 omicron variant surges. We used our real-world data platform to evaluate the effect of nirmatrelvir\u2013ritonavir treatment on 28-day hospitalisation, mortality, and emergency department visits among outpatients with early symptomatic COVID-19 during a SARS-CoV-2 omicron (BA.2, BA2.12.1, BA.4, and BA.5) predominant period in Colorado, USA.<\/p>\n\n\n\n

Methods<\/h3>\n\n\n\n

We did a propensity-matched, retrospective, observational cohort study of non-hospitalised adult patients infected with SARS-CoV-2 between March 26 and Aug 25, 2022, using records from a statewide health system in Colorado. We obtained data from the electronic health records of University of Colorado Health, the largest health system in Colorado, with 13 hospitals and 141\u2009000 annual hospital admissions, and with numerous ambulatory sites and affiliated pharmacies around the state. Included patients had a positive SARS-CoV-2 test or nirmatrelvir\u2013ritonavir medication order. Exclusion criteria were an order for or administration of other SARS-CoV-2 treatments within 10 days of a positive SARS-CoV-2 test, hospitalisation at the time of positive SARS-CoV-2 test, and positive SARS-CoV-2 test more than 10 days before a nirmatrelvir\u2013ritonavir order. We propensity score matched patients treated with nirmatrelvir\u2013ritonavir with untreated patients. The primary outcome was 28-day all-cause hospitalisation.<\/p>\n\n\n\n

Findings<\/h3>\n\n\n\n

Among 28\u2009167 patients infected with SARS-CoV-2 between March 26 and Aug 25, 2022, 21\u2009493 met the study inclusion criteria. 9881 patients received treatment with nirmatrelvir\u2013ritonavir and 11\u2009612 were untreated. Nirmatrelvir\u2013ritonavir treatment was associated with reduced 28-day all-cause hospitalisation compared with no antiviral treatment (61 [0\u00b79%] of 7168 patients vs<\/em> 135 [1\u00b74%] of 9361 patients, adjusted odds ratio (OR) 0\u00b745 [95% CI 0\u00b733\u20130\u00b762]; p<0\u00b70001). Nirmatrelvir\u2013ritonavir treatment was also associated with reduced 28-day all-cause mortality (two [<0\u00b71%] of 7168 patients vs<\/em> 15 [0\u00b72%] of 9361 patients; adjusted OR 0\u00b715 [95% CI 0\u00b703\u20130\u00b750]; p=0\u00b70010). Using subsequent emergency department visits as a surrogate for clinically significant relapse, we observed a decrease after nirmatrelvir\u2013ritonavir treatment (283 [3\u00b79%] of 7168 patients vs<\/em> 437 [4\u00b77%] of 9361 patients; adjusted OR 0\u00b774 [95% CI 0\u00b763\u20130\u00b787]; p=0\u00b70002).<\/p>\n\n\n\n

\"\"\/
Figure 1. Cumulative incidence plots for all-cause hospitalisation to day 28 by treatment status<\/figcaption><\/figure>\n\n\n\n
\"\"\/
Figure 2. Severity of all-cause hospitalisation to day 28
Total sample size of the hospitalised subset was 196 (61 patients in the nirmatrelvir\u2013ritonavir group and 135 in the untreated group).<\/figcaption><\/figure>\n\n\n\n
\"\"\/
Figure 3. Forest plot for subgroup analysis of outpatients infected with omicron
The primary outcome for all subgroup analyses was 28-day all-cause hospitalisation, and all subgroup models were adjusted for all variables in the primary analysis. Raw counts and proportions are presented, along with the adjusted OR (95% CI) for the treatment effect in the subgroup of interest. OR=odds ratio.<\/figcaption><\/figure>\n\n\n\n

Interpretation<\/h3>\n\n\n\n

Real-world evidence reported during a BA.2, BA2.12.1, BA.4, and BA.5 omicron surge showed an association between nirmatrelvir\u2013ritonavir treatment and reduced 28-day all-cause hospitalisation, all-cause mortality, and visits to the emergency department. With results that are among the first to suggest effectiveness of nirmatrelvir\u2013ritonavir for non-hospitalised patients during an omicron period inclusive of BA.4 and BA.5 subvariants, these data support nirmatrelvir\u2013ritonavir as an ongoing first-line treatment for adults acutely infected with SARS-CoV-2.<\/p>\n\n\n\n

Funding<\/h3>\n\n\n\n

US National Institutes of Health.<\/p>\n","protected":false},"excerpt":{"rendered":"

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