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Kaboré JL, Laffont B, Diop M, Tardif MR, Turgeon AF, Dumaresq J, Luong ML, Cauchon M, Chapdelaine H, Claveau D, Brosseau M, Haddad E, Benigeri M. Real-World Effectiveness of Nirmatrelvir/Ritonavir on Coronavirus Disease 2019-Associated Hospitalization Prevention: A Population-based Cohort Study in the Province of Quebec, Canada. Clin Infect Dis 2023; 77:805-815. [PMID: 37149726 DOI: 10.1093/cid/ciad287] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 05/08/2023] Open
Abstract
BACKGROUND Nirmatrelvir/ritonavir has shown to reduce COVID-19 hospitalization and death before Omicron, but updated real-world evidence studies are needed. This study aimed to assess whether nirmatrelvir/ritonavir reduces the risk of COVID-19-associated hospitalization among high-risk outpatients. METHODS A retrospective cohort study of outpatients with SARS-CoV-2 between March 15 and 15 October 2022, using data from the Quebec clinico-administrative databases. Outpatients treated with nirmatrelvir/ritonavir were compared with infected ones not receiving nirmatrelvir/ritonavir using propensity-score matching. Relative risk (RR) of COVID-19-associated hospitalization within 30 days was assessed using a Poisson regression. RESULTS A total of 8402 treated outpatients were matched to controls. Regardless of vaccination status, nirmatrelvir/ritonavir treatment was associated with a 69% reduced RR of hospitalization (RR: .31; 95% CI: .28; .36; number needed to treat [NNT] = 13). The effect was more pronounced in outpatients with incomplete primary vaccination (RR: .04; 95% CI: .03; .06; NNT = 8), while no benefit was found in those with a complete primary vaccination (RR: .93; 95% CI: .78; 1.08). Subgroups analysis among high-risk outpatients with a complete primary vaccination showed that nirmatrelvir/ritonavir treatment was associated with a significant decrease in the RR of hospitalization in severely immunocompromised outpatients (RR: .66; 95% CI: .50; .89; NNT = 16) and in high-risk outpatients aged ≥70 years (RR: .50; 95% CI: .34; .74; NNT = 10) when the last dose of the vaccine was received at least 6 months ago. CONCLUSIONS Nirmatrelvir/ritonavir reduces the risk of COVID-19-associated hospitalization among incompletely vaccinated high-risk outpatients and among some subgroups of completely vaccinated high-risk outpatients.
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Affiliation(s)
- Jean-Luc Kaboré
- Institut National d'Excellence en Santé et Services Sociaux (INESSS) du Québec (Québec National Institute for Excellence in Health and Social Services), Quebec City, Quebec, Canada
| | - Benoît Laffont
- Institut National d'Excellence en Santé et Services Sociaux (INESSS) du Québec (Québec National Institute for Excellence in Health and Social Services), Quebec City, Quebec, Canada
| | - Mamadou Diop
- Institut National d'Excellence en Santé et Services Sociaux (INESSS) du Québec (Québec National Institute for Excellence in Health and Social Services), Quebec City, Quebec, Canada
| | - Melanie R Tardif
- Institut National d'Excellence en Santé et Services Sociaux (INESSS) du Québec (Québec National Institute for Excellence in Health and Social Services), Quebec City, Quebec, Canada
| | - Alexis F Turgeon
- Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), CHU de Québec-Université Laval Research Center, Quebec City, Quebec, Canada
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Jeannot Dumaresq
- Department of Microbiology-Infectiology and Immunology, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Department of Microbiology and Infectious Diseases, Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Lévis, Quebec, Canada
| | - Me-Linh Luong
- Division of Infectious Diseases, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Michel Cauchon
- Department of Family Practice and Emergency, Université Laval, Quebec City, Quebec, Canada
| | - Hugo Chapdelaine
- Institut de Recherches Cliniques de Montréal, University of Montreal, Montreal, Quebec, Canada
- Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherches du CHUM, Montreal, Quebec, Canada
| | - David Claveau
- Departments of Emergency Medicine and Critical Care Medicine, Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec, Centre Hospitalier Affilié Universitaire Régional, Trois-Rivières, Quebec, Canada
| | - Marc Brosseau
- Department of Medicine, Pulmonary and Critical Care Medicine Divisions, Hôpital Maisonneuve-Rosemont, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Elie Haddad
- Department of Pediatrics, University of Montreal, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Mike Benigeri
- Institut National d'Excellence en Santé et Services Sociaux (INESSS) du Québec (Québec National Institute for Excellence in Health and Social Services), Quebec City, Quebec, Canada
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