Real-World Effectiveness of Nirmatrelvir-ritonavir Treatment in High-risk COVID-19 Patients.

배경: Evidence of the effectiveness of nirmatrelvir-ritonavir in the real-world, where the omicron variant of SARS-CoV-2 is dominant and most of the population at risk had been vaccinated, is lacking. 방법: A retrospective cohort study was performed at four COVID-19-designated hospitals in Seoul, Korea. Mild COVID-19 patients who had risk factors for disease progression (aged 60 years and over or aged 40 years and over with underlying disease) and were admitted to the hospitals from February to April 2022 within five days of symptom onset were included. Nirmatrelvir-ritonavir recipients were matched to control using propensity scores (PS). The primary outcome was time to O2 support free survival and secondary outcome included a composite outcome of disease progression (applying mask, high flow nasal cannula, mechanical ventilator, or all-cause mortality). Multivariate analyses were conducted in the matched cohorts. 결과: A total of 634 mild COVID-19 patients (nirmatrelvir-ritonavir recipients (n = 258) and control (n = 376)) were included. After PS-matching, the analysis included 236 nirmatrelvir-ritonavir recipients and 236 controls. The Characteristics of participants were presented in Table. Nirmatrelvir-ritonavir recipients showed significantly longer O2 supporting-free survival than matched control, with adjusted hazard ratio (HR) 0.07 (95% C.I. 0.01, 0.30; P <0.001) (Figure). Multivariable Cox regression analysis found that nirmatrelvir-ritonavir, age (HR 1.03, 95% C.I. 1.00, 1.07), NEWS2 score at admission (HR 1.36, 95% C.I. 1.08, 1.71), women (HR 0.37, 95% C.I. 0.15, 0.88), and days from symptom onset to admission (HR 0.67, 95% C.I. 0.48, 0.95) were significantly associated with O2 supporting. However, any factor did not show a reduced risk for progression to a composite outcome of severe disease. 결론: Nirmatrelvir-ritonavir treatment was associated with a reduced risk of progression to O2 support for high-risk COVID-19 patients. [ABSTRACT FROM AUTHOR]