T. Yip, G. Lui, Mandy Sze-Man Lai, V. Wong, Y. Tse, Bosco Ma, Elsie Hui, Maria Kw Leung, H. Chan, D. S. Hui, G. Wong
{"title":"口服抗病毒药物使用对社区COVID-19患者住院风险的影响","authors":"T. Yip, G. Lui, Mandy Sze-Man Lai, V. Wong, Y. Tse, Bosco Ma, Elsie Hui, Maria Kw Leung, H. Chan, D. S. Hui, G. Wong","doi":"10.2139/ssrn.4112160","DOIUrl":null,"url":null,"abstract":"ABSTRACT Background We examined the effectiveness of molnupiravir and nirmatrelvir/ritonavir in reducing hospitalization and deaths in a real-world cohort of non-hospitalized COVID-19 patients. Methods This was a territory-wide retrospective cohort study in Hong Kong. Non-hospitalized COVID-19 patients who attended designated outpatient clinics between 16 February and 31 March 2022 were identified. Patients hospitalized on the day of the first clinic appointment or used both oral antivirals were excluded. The primary endpoint was hospitalization. The secondary endpoint was a composite of intensive care unit admission, invasive mechanical ventilation use, and/or death. Results Of 93,883 patients, 83,154 (88.6%), 5,808 (6.2%), and 4,921 (5.2%) were oral antiviral non-users, molnupiravir users, and nirmatrelvir/ritonavir users respectively. Compared to non-users, oral antiviral users were older and had more comorbidities, lower complete vaccination rate, and more hospitalizations in the previous year. Molnupiravir users were older, and had more comorbidities, lower complete vaccination rate, and more hospitalizations in the previous year than nirmatrelvir/ritonavir users. At a median follow-up of 30 days, 1,931 (2.1%) patients were hospitalized and 225 (0.2%) patients developed the secondary endpoint. After propensity score weighting, nirmatrelvir/ritonavir use (weighted hazard ratio 0.79, 95%CI 0.65-0.95, P = 0.011) but not molnupiravir use (weighted hazard ratio 1.17, 95%CI 0.99-1.39, P = 0.062) was associated with a reduced risk of hospitalization than non-users. The use of molnupiravir or nirmatrelvir/ritonavir was not associated with a lower risk of the secondary endpoint as compared to non-users. Conclusion Use of nirmatrelvir/ritonavir but not molnupiravir was associated with a reduced risk of hospitalization in real-world non-hospitalized COVID-19 patients.","PeriodicalId":10421,"journal":{"name":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2022-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"40","resultStr":"{\"title\":\"Impact of the use of oral antiviral agents on the risk of hospitalization in community COVID-19 patients\",\"authors\":\"T. Yip, G. Lui, Mandy Sze-Man Lai, V. Wong, Y. Tse, Bosco Ma, Elsie Hui, Maria Kw Leung, H. Chan, D. S. Hui, G. Wong\",\"doi\":\"10.2139/ssrn.4112160\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"ABSTRACT Background We examined the effectiveness of molnupiravir and nirmatrelvir/ritonavir in reducing hospitalization and deaths in a real-world cohort of non-hospitalized COVID-19 patients. Methods This was a territory-wide retrospective cohort study in Hong Kong. Non-hospitalized COVID-19 patients who attended designated outpatient clinics between 16 February and 31 March 2022 were identified. Patients hospitalized on the day of the first clinic appointment or used both oral antivirals were excluded. The primary endpoint was hospitalization. The secondary endpoint was a composite of intensive care unit admission, invasive mechanical ventilation use, and/or death. Results Of 93,883 patients, 83,154 (88.6%), 5,808 (6.2%), and 4,921 (5.2%) were oral antiviral non-users, molnupiravir users, and nirmatrelvir/ritonavir users respectively. Compared to non-users, oral antiviral users were older and had more comorbidities, lower complete vaccination rate, and more hospitalizations in the previous year. Molnupiravir users were older, and had more comorbidities, lower complete vaccination rate, and more hospitalizations in the previous year than nirmatrelvir/ritonavir users. At a median follow-up of 30 days, 1,931 (2.1%) patients were hospitalized and 225 (0.2%) patients developed the secondary endpoint. After propensity score weighting, nirmatrelvir/ritonavir use (weighted hazard ratio 0.79, 95%CI 0.65-0.95, P = 0.011) but not molnupiravir use (weighted hazard ratio 1.17, 95%CI 0.99-1.39, P = 0.062) was associated with a reduced risk of hospitalization than non-users. The use of molnupiravir or nirmatrelvir/ritonavir was not associated with a lower risk of the secondary endpoint as compared to non-users. Conclusion Use of nirmatrelvir/ritonavir but not molnupiravir was associated with a reduced risk of hospitalization in real-world non-hospitalized COVID-19 patients.\",\"PeriodicalId\":10421,\"journal\":{\"name\":\"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2022-08-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"40\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2139/ssrn.4112160\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2139/ssrn.4112160","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 40
摘要
背景:我们研究了莫努匹拉韦和尼马特利韦/利托那韦在现实世界非住院COVID-19患者队列中降低住院和死亡的有效性。方法:本研究是在香港进行的一项区域性回顾性队列研究。确定了2022年2月16日至3月31日期间在指定门诊就诊的非住院COVID-19患者。排除首次门诊预约当天住院或同时使用两种口服抗病毒药物的患者。主要终点是住院。次要终点是重症监护病房入住、有创机械通气使用和/或死亡的综合指标。结果93,883例患者中,83,154例(88.6%)、5,808例(6.2%)和4,921例(5.2%)分别为口服抗病毒药物非使用者、莫努匹拉韦使用者和尼马特利韦/利托那韦使用者。与非服用者相比,口服抗病毒药物服用者年龄更大,合并症更多,完全疫苗接种率更低,前一年住院次数更多。与尼马特里韦/利托那韦使用者相比,莫硝吡韦使用者年龄更大,合并症更多,完全疫苗接种率更低,前一年住院次数更多。中位随访时间为30天,1,931例(2.1%)患者住院,225例(0.2%)患者出现次要终点。在倾向评分加权后,尼马特利韦/利托那韦的使用(加权风险比0.79,95%CI 0.65-0.95, P = 0.011)与住院风险降低相关,而莫那匹拉韦的使用(加权风险比1.17,95%CI 0.99-1.39, P = 0.062)与住院风险降低无关。与非使用者相比,使用莫努匹拉韦或尼马特利韦/利托那韦与次要终点风险降低无关。结论:在现实世界的非住院COVID-19患者中,使用尼马特利韦/利托那韦而不使用莫努匹拉韦与住院风险降低相关。
Impact of the use of oral antiviral agents on the risk of hospitalization in community COVID-19 patients
ABSTRACT Background We examined the effectiveness of molnupiravir and nirmatrelvir/ritonavir in reducing hospitalization and deaths in a real-world cohort of non-hospitalized COVID-19 patients. Methods This was a territory-wide retrospective cohort study in Hong Kong. Non-hospitalized COVID-19 patients who attended designated outpatient clinics between 16 February and 31 March 2022 were identified. Patients hospitalized on the day of the first clinic appointment or used both oral antivirals were excluded. The primary endpoint was hospitalization. The secondary endpoint was a composite of intensive care unit admission, invasive mechanical ventilation use, and/or death. Results Of 93,883 patients, 83,154 (88.6%), 5,808 (6.2%), and 4,921 (5.2%) were oral antiviral non-users, molnupiravir users, and nirmatrelvir/ritonavir users respectively. Compared to non-users, oral antiviral users were older and had more comorbidities, lower complete vaccination rate, and more hospitalizations in the previous year. Molnupiravir users were older, and had more comorbidities, lower complete vaccination rate, and more hospitalizations in the previous year than nirmatrelvir/ritonavir users. At a median follow-up of 30 days, 1,931 (2.1%) patients were hospitalized and 225 (0.2%) patients developed the secondary endpoint. After propensity score weighting, nirmatrelvir/ritonavir use (weighted hazard ratio 0.79, 95%CI 0.65-0.95, P = 0.011) but not molnupiravir use (weighted hazard ratio 1.17, 95%CI 0.99-1.39, P = 0.062) was associated with a reduced risk of hospitalization than non-users. The use of molnupiravir or nirmatrelvir/ritonavir was not associated with a lower risk of the secondary endpoint as compared to non-users. Conclusion Use of nirmatrelvir/ritonavir but not molnupiravir was associated with a reduced risk of hospitalization in real-world non-hospitalized COVID-19 patients.