Effectiveness of Oral Nirmatrelvir/Ritonavir vs. Intravenous Three-Day Remdesivir in Preventing Progression to Severe COVID-19: A Single-Center, Prospective, Comparative, Real-Life Study
Background: Nirmatrelvir/ritonavir (NMV/r) and three-day course remdesivir (3RDV) have been approved as early treatments for COVID-19 outpatients not requiring supplemental oxygen. Real-life data on the efficacy of antivirals among immunocompromised patients or directly comparing their effectiveness...
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MDPI AG
2023-07-01
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| Series: | Viruses |
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| Online Access: | https://www.mdpi.com/1999-4915/15/7/1515 |
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| author | Dimitrios Basoulis Aristeidis Tsakanikas Aikaterini Gkoufa Aikaterini Bitsani Georgios Karamanakos Elpida Mastrogianni Vasiliki E. Georgakopoulou Sotiria Makrodimitri Pantazis-Michail Voutsinas Panagiota Lamprou Athanasios Kontos Stathis Tsiakas Maria N. Gamaletsou Smaragdi Marinaki Nikolaos V. Sipsas |
| author_facet | Dimitrios Basoulis Aristeidis Tsakanikas Aikaterini Gkoufa Aikaterini Bitsani Georgios Karamanakos Elpida Mastrogianni Vasiliki E. Georgakopoulou Sotiria Makrodimitri Pantazis-Michail Voutsinas Panagiota Lamprou Athanasios Kontos Stathis Tsiakas Maria N. Gamaletsou Smaragdi Marinaki Nikolaos V. Sipsas |
| author_sort | Dimitrios Basoulis |
| collection | DOAJ |
| description | Background: Nirmatrelvir/ritonavir (NMV/r) and three-day course remdesivir (3RDV) have been approved as early treatments for COVID-19 outpatients not requiring supplemental oxygen. Real-life data on the efficacy of antivirals among immunocompromised patients or directly comparing their effectiveness in preventing hospitalization and/or death are scarce. Methods: Prospective, observational study conducted in a tertiary care hospital, from 1 January 2022 until 15 March 2023, during the prevalence of the Omicron variant. Inverse probability of treatment weighting (IPTW) was used to account for differences between treatment groups. Results: We included 521, mainly immunocompromised (56%), patients in our analysis; 356 (68.3%) received 3RDV and 165 (31.7%) NMV/r. Overall, 15/521 (2.9%) patients met the primary end-point of hospitalization at 30 days (3RDV arm: 10/356, 2.8% vs. NMV/r arm: 5/165, 3%, <i>p</i> = 1). On IPTW-adjusted univariable analysis, the choice of treatment did not affect outcomes. In multivariable logistic regression analysis, we found that one (OR 0.26, 95%CI 0.07–0.99, <i>p</i> = 0.049) or two (OR 0.06, 95%CI 0.01–0.55, <i>p</i> = 0.014) vaccine booster shots reduced the risk for adverse outcomes. Conclusion: In our patient population of high-risk, mainly immunocompromised, vaccinated patients during the prevalence of the Omicron variant, NMV/r and 3RDV were equally effective early treatments for the prevention of hospitalization and/or death. |
| first_indexed | 2024-03-11T00:34:28Z |
| format | Article |
| id | doaj.art-aada0173fed046cbb59ed18a5a4ab658 |
| institution | Directory Open Access Journal |
| issn | 1999-4915 |
| language | English |
| last_indexed | 2024-03-11T00:34:28Z |
| publishDate | 2023-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Viruses |
| spelling | doaj.art-aada0173fed046cbb59ed18a5a4ab6582023-11-18T21:44:47ZengMDPI AGViruses1999-49152023-07-01157151510.3390/v15071515Effectiveness of Oral Nirmatrelvir/Ritonavir vs. Intravenous Three-Day Remdesivir in Preventing Progression to Severe COVID-19: A Single-Center, Prospective, Comparative, Real-Life StudyDimitrios Basoulis0Aristeidis Tsakanikas1Aikaterini Gkoufa2Aikaterini Bitsani3Georgios Karamanakos4Elpida Mastrogianni5Vasiliki E. Georgakopoulou6Sotiria Makrodimitri7Pantazis-Michail Voutsinas8Panagiota Lamprou9Athanasios Kontos10Stathis Tsiakas11Maria N. Gamaletsou12Smaragdi Marinaki13Nikolaos V. Sipsas14Infectious Diseases Unit, Laiko General Hospital, 115 27 Athens, GreeceInfectious Diseases Unit, Laiko General Hospital, 115 27 Athens, GreeceInfectious Diseases Unit, Laiko General Hospital, 115 27 Athens, GreeceInfectious Diseases Unit, Laiko General Hospital, 115 27 Athens, GreeceEmergency Department, Laiko General Hospital, 115 27 Athens, GreeceEmergency Department, Laiko General Hospital, 115 27 Athens, GreeceInfectious Diseases Unit, Laiko General Hospital, 115 27 Athens, GreeceInfectious Diseases Unit, Laiko General Hospital, 115 27 Athens, GreeceInfectious Diseases Unit, Laiko General Hospital, 115 27 Athens, GreecePulmonology Department, Laiko General Hospital, 115 27 Athens, GreeceDepartment of Pathophysiology, Laiko General Hospital, 115 27 Athens, GreeceDepartment of Nephrology and Renal Transplantation, Laiko General Hospital, 115 27 Athens, GreeceEmergency Department, Laiko General Hospital, 115 27 Athens, GreeceDepartment of Nephrology and Renal Transplantation, Laiko General Hospital, 115 27 Athens, GreeceInfectious Diseases Unit, Laiko General Hospital, 115 27 Athens, GreeceBackground: Nirmatrelvir/ritonavir (NMV/r) and three-day course remdesivir (3RDV) have been approved as early treatments for COVID-19 outpatients not requiring supplemental oxygen. Real-life data on the efficacy of antivirals among immunocompromised patients or directly comparing their effectiveness in preventing hospitalization and/or death are scarce. Methods: Prospective, observational study conducted in a tertiary care hospital, from 1 January 2022 until 15 March 2023, during the prevalence of the Omicron variant. Inverse probability of treatment weighting (IPTW) was used to account for differences between treatment groups. Results: We included 521, mainly immunocompromised (56%), patients in our analysis; 356 (68.3%) received 3RDV and 165 (31.7%) NMV/r. Overall, 15/521 (2.9%) patients met the primary end-point of hospitalization at 30 days (3RDV arm: 10/356, 2.8% vs. NMV/r arm: 5/165, 3%, <i>p</i> = 1). On IPTW-adjusted univariable analysis, the choice of treatment did not affect outcomes. In multivariable logistic regression analysis, we found that one (OR 0.26, 95%CI 0.07–0.99, <i>p</i> = 0.049) or two (OR 0.06, 95%CI 0.01–0.55, <i>p</i> = 0.014) vaccine booster shots reduced the risk for adverse outcomes. Conclusion: In our patient population of high-risk, mainly immunocompromised, vaccinated patients during the prevalence of the Omicron variant, NMV/r and 3RDV were equally effective early treatments for the prevention of hospitalization and/or death.https://www.mdpi.com/1999-4915/15/7/1515nirmatrelvir/ritonavirremdesivirCOVID-19inverse-probability of treatment weightingimmunocompromised patients |
| spellingShingle | Dimitrios Basoulis Aristeidis Tsakanikas Aikaterini Gkoufa Aikaterini Bitsani Georgios Karamanakos Elpida Mastrogianni Vasiliki E. Georgakopoulou Sotiria Makrodimitri Pantazis-Michail Voutsinas Panagiota Lamprou Athanasios Kontos Stathis Tsiakas Maria N. Gamaletsou Smaragdi Marinaki Nikolaos V. Sipsas Effectiveness of Oral Nirmatrelvir/Ritonavir vs. Intravenous Three-Day Remdesivir in Preventing Progression to Severe COVID-19: A Single-Center, Prospective, Comparative, Real-Life Study Viruses nirmatrelvir/ritonavir remdesivir COVID-19 inverse-probability of treatment weighting immunocompromised patients |
| title | Effectiveness of Oral Nirmatrelvir/Ritonavir vs. Intravenous Three-Day Remdesivir in Preventing Progression to Severe COVID-19: A Single-Center, Prospective, Comparative, Real-Life Study |
| title_full | Effectiveness of Oral Nirmatrelvir/Ritonavir vs. Intravenous Three-Day Remdesivir in Preventing Progression to Severe COVID-19: A Single-Center, Prospective, Comparative, Real-Life Study |
| title_fullStr | Effectiveness of Oral Nirmatrelvir/Ritonavir vs. Intravenous Three-Day Remdesivir in Preventing Progression to Severe COVID-19: A Single-Center, Prospective, Comparative, Real-Life Study |
| title_full_unstemmed | Effectiveness of Oral Nirmatrelvir/Ritonavir vs. Intravenous Three-Day Remdesivir in Preventing Progression to Severe COVID-19: A Single-Center, Prospective, Comparative, Real-Life Study |
| title_short | Effectiveness of Oral Nirmatrelvir/Ritonavir vs. Intravenous Three-Day Remdesivir in Preventing Progression to Severe COVID-19: A Single-Center, Prospective, Comparative, Real-Life Study |
| title_sort | effectiveness of oral nirmatrelvir ritonavir vs intravenous three day remdesivir in preventing progression to severe covid 19 a single center prospective comparative real life study |
| topic | nirmatrelvir/ritonavir remdesivir COVID-19 inverse-probability of treatment weighting immunocompromised patients |
| url | https://www.mdpi.com/1999-4915/15/7/1515 |
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