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KMID : 0191120230380350272
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Journal of Korean Medical Science
2023 Volume.38 No. 35 p.272 ~ p.272
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Real-World Effectiveness of Nirmatrelvir-Ritonavir and Its Acceptability in High-Risk COVID-19 Patients
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Kim Min-Kyung
Lee Kyung-Shin
Ham Sin-Young
Choi Youn-Young
Lee Eun-Young
Lee Seung-Jae
Lee Bo-Ra
Jeon Jae-Hyun
Chin Bum-Sik
Kim Yeon-Jae
Kim Ga-Yeon
Jang Hee-Chang
Choi Jae-Phil
Park Sang-Won
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Abstract
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Background : Nirmatrelvir-ritonavir is highly effective in preventing severe coronavirus disease 2019 (COVID-19) in high-risk patients with mild-to-moderate severity. However, real-world performance data are limited, and the drug is not so acceptable to the COVID-19 patients at high risk who need it in Korea.
Methods : To evaluate the effectiveness of nirmatrelvir-ritonavir, we conducted a propensity score-matched retrospective cohort study on patients with mild-to-moderate COVID-19 at high risk for a severe disease who were hospitalized at four hospitals in South Korea from February 2022 to April 2022. A total of 236 patients in the treatment group (administered nirmatrelvir-ritonavir) and 236 in the matched control group (supportive care only) were analyzed for the primary outcome, i.e., the time to oxygen support-free survival. The secondary outcome was a composite result of disease progression. The reason for not prescribing nirmatrelvir-ritonavir to the indicated patients was also investigated.
Results : The treatment group showed significantly longer oxygen support-free survival than the matched control group (adjusted hazard ratio [aHR], 0.07; 95% confidence interval [CI], 0.01?0.31; P < 0.001). Multivariate Cox regression analysis showed that age (aHR, 1.03; 95% CI, 1.00?1.07), National Early Warning Score-2 at admission (aHR, 1.36; 95% CI, 1.08?1.71), nirmatrelvir-ritonavir treatment, female sex (aHR, 0.37; 95% CI, 0.15?0.88), and time from symptom onset to admission (aHR, 0.67; 95% CI, 0.48?0.95) were significantly associated with oxygen therapy. However, none of the factors were related to the composite outcome. In the unmatched control group, 19.9% of 376 patients had documented explanations for nirmatrelvir-ritonavir non-prescription, and 44.0% of these were due to contraindication criteria. In the treatment group, 10.9% of patients discontinued the medication primarily because of adverse events (71.4%), with gastrointestinal symptoms being the most common (50.0%).
Conclusion : Nirmatrelvir-ritonavir treatment significantly reduced oxygen therapy requirements in high-risk patients with COVID-19 during the omicron variant surge in South Korea. Physicians are encouraged to consider the active use of nirmatrelvir-ritonavir and to be watchful for gastrointestinal symptoms during medication.
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KEYWORD
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Nirmatrelvir-Ritonavir, COVID-19, Effectiveness, Retrospective Cohort Study
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