{"id":23931,"date":"2023-05-22T04:52:00","date_gmt":"2023-05-21T20:52:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=23931"},"modified":"2023-05-22T06:12:49","modified_gmt":"2023-05-21T22:12:49","slug":"bmj%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%a5%88%e7%8e%9b%e7%89%b9%e9%9f%a6%e5%8f%8a%e6%96%b0%e5%86%a0%e7%97%85%e6%af%92%e6%84%9f%e6%9f%93%e6%82%a3%e8%80%85%e4%bd%8f%e9%99%a2%e6%88%96","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=23931","title":{"rendered":"[BMJ\u53d1\u8868\u8bba\u6587]\uff1a\u5948\u739b\u7279\u97e6\u53ca\u65b0\u51a0\u75c5\u6bd2\u611f\u67d3\u60a3\u8005\u4f4f\u9662\u6216\u6b7b\u4ea1\u98ce\u9669"},"content":{"rendered":"\n

Research<\/strong><\/p>\n\n\n\n

Nirmatrelvir and risk of hospital admission or death in adults with covid-19: emulation of a randomized target trial using electronic health records<\/h1>\n\n\n\n

Yan Xie, Benjamin Bowe, Ziyad Al-Aly<\/h3>\n\n\n\n

BMJ<\/em>\u00a02023;\u00a0381\u00a0doi:\u00a0https:\/\/doi.org\/10.1136\/bmj-2022-073312<\/a>\u00a0(Published 11 April 2023)Cite this as:\u00a0BMJ<\/em>\u00a02023;381:e073312<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

Objective<\/strong> To estimate the effectiveness of nirmatrelvir, compared with no treatment, in reducing admission to hospital or death at 30 days in people infected with the SARS-CoV-2 virus and at risk of developing severe disease, according to vaccination status and history of previous SARS-CoV-2 infection.<\/p>\n\n\n\n

Design<\/strong> Emulation of a randomized target trial with electronic health records.<\/p>\n\n\n\n

Setting<\/strong> Healthcare databases of the US Department of Veterans Affairs<\/p>\n\n\n\n

Participants<\/strong> 256\u2009288 participants with a SARS-CoV-2 positive test result and at least one risk factor for developing severe covid-19 disease, between 3 January and 30 November 2022. 31\u2009524 were treated with nirmatrelvir within five days of testing positive for SARS-CoV-2 and 224\u2009764 received no treatment.<\/p>\n\n\n\n

Main outcome measures<\/strong> The effectiveness of starting nirmatrelvir within five days of a positive SARS-CoV-2 test result versus no treatment in reducing the risk of admission to hospital or death at 30 days was estimated in those who were not vaccinated, in those who received one or two doses of vaccine, and those who received a vaccine booster and, separately, in participants with a primary SARS-CoV-2 infection or reinfection. The inverse probability weighting method was used to balance personal and health characteristics between the groups. Relative risk and absolute risk reduction were computed from cumulative incidence at 30 days, estimated by weighted Kaplan-Meier estimator.<\/p>\n\n\n\n

Results<\/strong> Among people who were not vaccinated (n=76\u2009763; 5338 nirmatrelvir and 71\u2009425 no treatment), compared with no treatment, the relative risk of nirmatrelvir in reducing admission to hospital or death at 30 days was 0.60 (95% confidence interval 0.50 to 0.71); the absolute risk reduction was 1.83% (95% confidence interval 1.29% to 2.49%). The relative risk and absolute risk reduction, compared with no treatment, were 0.65 (0.57 to 0.74) and 1.27% (0.90% to 1.61%), respectively, in people who received one or two doses of vaccine (n=84\u2009620; 7989 nirmatrelvir and 76\u2009631 no treatment); 0.64 (0.58 to 0.71) and 1.05% (0.85% to 1.27%) in individuals who received a booster dose of vaccine (n=94\u2009905; 18\u2009197 nirmatrelvir and 76\u2009708 no treatment); 0.61 (0.57 to 0.65) and 1.36% (1.19% to 1.53%) in participants with a primary SARS-CoV-2 infection (n=228\u2009081; 26\u2009350 nirmatrelvir and 201\u2009731 no treatment); and 0.74 (0.63 to 0.87) and 0.79% (0.36% to 1.18%) in participants who were reinfected with the SARS-CoV-2 virus (n=28\u2009207; 5174 nirmatrelvir and 23\u2009033 no treatment). Nirmatrelvir was associated with a reduced risk of admission to hospital or death in those aged \u226465 years and > 65 years; in men and women; in black and white participants; in those with 1-2, 3-4, and \u22655 risk factors for progression to severe covid-19 illness; and in those infected during the omicron BA.1 or BA.2 predominant era, and the BA.5 predominant era.<\/p>\n\n\n\n

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Conclusions<\/strong> In people with SARS-CoV-2 infection who were at risk of developing severe disease, compared with no treatment, nirmatrelvir was associated with a reduced risk of admission to hospital or death at 30 days in people who were not vaccinated, vaccinated, and had received a booster vaccine, and in those with a primary SARS-CoV-2 infection and reinfection.<\/p>\n","protected":false},"excerpt":{"rendered":"

Research Nirmatrelvir and risk of hospital admission or […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/23931"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=23931"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/23931\/revisions"}],"predecessor-version":[{"id":23932,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/23931\/revisions\/23932"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=23931"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=23931"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=23931"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}