In a recent study published in the Journal of the American Medical Association Network Open, researchers conducted a cohort study to explore the correlation of nirmatrelvir-ritonavir (Paxlovid) with the prevention of mortality or admission to hospital in individuals with different risks of complications from COVID-19 infection.

Researchers from the University of British Columbia in Vancouver examined rates of severe COVID-19 outcomes among 6,866 adults with COVID-19 from February 1, 2022, to February 3, 2023, a period dominated by the Omicron variant.

Patients were eligible if they belonged to one of four higher risk groups of individuals who received priority for COVID-19 vaccination. The patients were categorized into four groups. Three of the four groups were comprised of clinically extremely vulnerable (CEV) patient groups, including those with severely impaired immune systems (CEV1), those with moderately weakened immune systems (CEV2), and those with healthy immune systems but underlying high-risk conditions (CEV3). A fourth group (EXEL) was comprised of unvaccinated, non-CEV patients aged 70 years and older with other chronic conditions given more extensive access to Paxlovid. Paxlovid recipients were matched to patients in the same vulnerability group.

The primary outcome for this study was mortality due to any cause or emergency hospitalization with COVID-19 within 28 days. The study included 6,866 individuals, of whom 3,888 (56.6%) were female and whose median (IQR) age was 70 (57-80) years.

The results revealed, “Compared with unexposed controls, treatment with nirmatrelvir and ritonavir was linked with statistically significant relative reductions in the primary outcome in the CEV1 group (560 patients; risk difference [RD], –2.5%, 95% CI, –4.8% to –0.2%) and the CEV2 group (2,628 patients; RD, –1.7%; 95% CI, –2.9% to –0.5%). In the CEV3 group, the RD was –1.3%, but the findings were not statistically significant (2,100 patients; 95% CI, –2.8% to 0.1%). In the EXEL group, treatment was linked with a greater risk of the outcome (RD, 1.0%), but the findings were not statistically significant (1,578 patients; 95% CI, –0.9% to 2.9%).”

Based on their findings, the authors concluded, “In this cohort study of 6,866 individuals in British Columbia, nirmatrelvir and ritonavir treatment was associated with reduced risk of COVID-19 hospitalization or death in CEV individuals, with the greatest benefit observed in severely immunocompromised individuals. No reduction in the primary outcome was observed in lower-risk individuals, including those aged 70 years or older without serious comorbidities.”

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