Welcome to PracticeUpdate! We hope you are enjoying access to a selection of our top-read and most recent articles. Please register today for a free account and gain full access to all of our expert-selected content.
Already Have An Account? Log in Now
Effectiveness of Nirmatrelvir–Ritonavir Against the Development of Post–COVID-19 Conditions Among US Veterans
TAKE-HOME MESSAGE
- In this retrospective target trial emulation study that used the electronic data from the Veterans Health Administration, the incidence of post–COVID-19 conditions (PCCs) was compared between 9593 non-hospitalized veterans with COVID-19 who were prescribed nirmatrelvir–ritonavir and 9593 matched untreated comparators. In the 31 to 180 days following infection, the nirmatrelvir–ritonavir group and the matched untreated comparator group had a comparable incidence of most PCCs, except for a lower combined risk of venous thromboembolism and pulmonary embolism noted in the nirmatrelvir–ritonavir group.
- Prior smaller observational studies suggested that treatment of outpatients with COVID-19 with nirmatrelvir–ritonavir pharmacotherapy may have benefits beyond the acute illness, including a reduced risk of PCCs. The current study indicates that the prevention of PCCs should not be the deciding factor in prescribing nirmatrelvir–ritonavir.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
COVID-19 has been linked to the development of many post-COVID-19 conditions (PCCs) after acute infection. Limited information is available on the effectiveness of oral antivirals used to treat acute COVID-19 in preventing the development of PCCs.
OBJECTIVE
To measure the effectiveness of outpatient treatment of COVID-19 with nirmatrelvir-ritonavir in preventing PCCs.
DESIGN
Retrospective target trial emulation study comparing matched cohorts receiving nirmatrelvir-ritonavir versus no treatment.
SETTING
Veterans Health Administration (VHA).
PARTICIPANTS
Nonhospitalized veterans in VHA care who were at risk for severe COVID-19 and tested positive for SARS-CoV-2 during January through July 2022.
INTERVENTION
Nirmatrelvir-ritonavir treatment for acute COVID-19.
MEASUREMENTS
Cumulative incidence of 31 potential PCCs at 31 to 180 days after treatment or a matched index date, including cardiac, pulmonary, renal, thromboembolic, gastrointestinal, neurologic, mental health, musculoskeletal, endocrine, and general conditions and symptoms.
RESULTS
Eighty-six percent of the participants were male, with a median age of 66 years, and 17.5% were unvaccinated. Baseline characteristics were well balanced between participants treated with nirmatrelvir-ritonavir and matched untreated comparators. No differences were observed between participants treated with nirmatrelvir-ritonavir (n = 9593) and their matched untreated comparators in the incidence of most PCCs examined individually or grouped by organ system, except for lower combined risk for venous thromboembolism and pulmonary embolism (subhazard ratio, 0.65 [95% CI, 0.44 to 0.97]; cumulative incidence difference, -0.29 percentage points [CI, -0.52 to -0.05 percentage points]).
LIMITATIONS
Ascertainment of PCCs using International Classification of Diseases, 10th Revision codes may be inaccurate. Evaluation of many outcomes could have resulted in spurious associations with combined thromboembolic events by chance.
CONCLUSION
Out of 31 potential PCCs, only combined thromboembolic events seemed to be reduced by nirmatrelvir-ritonavir.
PRIMARY FUNDING SOURCE
U.S. Department of Veterans Affairs.
Additional Info
Disclosure statements are available on the authors' profiles:
Effectiveness of Nirmatrelvir-Ritonavir Against the Development of Post-COVID-19 Conditions Among U.S. Veterans : A Target Trial Emulation
Ann. Intern. Med 2023 Oct 31;[EPub Ahead of Print], GN Ioannou, K Berry, N Rajeevan, Y Li, P Mutalik, L Yan, D Bui, F Cunningham, DM Hynes, M Rowneki, A Bohnert, EJ Boyko, TJ Iwashyna, ML Maciejewski, TF Osborne, EM Viglianti, M Aslan, GD Huang, KL BajemaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.