Nirmatrelvir plus ritonavir may reduce risk for hospitalization or death from COVID-19

Abstract: https://www.acpjournals.org/doi/10.7326/M22-2141     

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A retrospective cohort study of more than 44,000 nonhospitalized persons diagnosed with COVID-19 found that nirmatrelvir plus ritonavir reduced the overall risk of hospitalization and death. The study is published in Annals of Internal Medicine.

In the EPIC-HR (Evaluation of Protease Inhibition for Covid-19 in High-Risk Patients) trial, nirmatrelvir plus ritonavir led to an 89% reduction in hospitalization or death among unvaccinated outpatients with early COVID-19. The World Health Organization recommended nirmatrelvir plus ritonavir in April 2022, but only for the highest-risk persons and advised against use in most vaccinated and other lower-risk persons. The clinical impact of nirmatrelvir plus ritonavir among vaccinated populations is uncertain.

Researchers from Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health studied 44,551 nonhospitalized persons with COVID-19 aged 50 years or older in the Mass General Brigham healthcare system to assess whether nirmatrelvir plus ritonavir could reduce the risk for hospitalization or death in the setting of prevalent SARS-CoV-2 immunity and immune-evasive SARS-CoV-2 lineages. More than 90% of participants had at least 3 vaccine doses at the time of the study. During the study period, 28.1% of participants received nirmatrelvir plus ritonavir and 71.9% did not. The authors found that recipients of nirmatrelvir plus ritonavir had 40% lower risk for hospitalization and 71% lower risk of death, although the risk for either was already very low (less than 1%). Overall, the mortality rate among persons prescribed nirmatrelvir plus ritonavir was 0.55% and 0.97% among persons who were not. The authors note that among those who were diagnosed as outpatients, Black, Hispanic, or Latinx patients had much lower rates of prescription of nirmatrelvir plus ritonavir. To realize the public health potential of outpatient COVID-19 therapy, clinicians must address this gap and these disparities.

 

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected]. To speak with corresponding author Scott Dryden-Peterson, MD, MSc, please contact Mark Murphy at [email protected].