Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Feb;95(2):e28441.
doi: 10.1002/jmv.28441.

Efficacy and safety of nirmatrelvir/ritonavir (Paxlovid) for COVID-19: A rapid review and meta-analysis

Behnam Amani  1 , Bahman Amani  1
Affiliations
Review

Efficacy and safety of nirmatrelvir/ritonavir (Paxlovid) for COVID-19: A rapid review and meta-analysis

Behnam Amani et al. J Med Virol. 2023 Feb.

Abstract

This study aimed to examine the efficacy and safety of nirmatrelvir/ritonavir (Paxlovid) for coronavirus disease 2019 (COVID-19). PubMed, Cochrane Library, Web of Science, medRxiv, and Google Scholar were searched to identify the relevant evidence up to November 10, 2022. The reference lists of key studies were also scanned to find additional records. The quality of the studies was evaluated using the Cochrane tools for assessing the risk of bias. The Comprehensive Meta-Analysis software version 3.0 was employed for data analysis. Twenty-three studies involving 314 353 patients were included in the analysis. The findings of the meta-analysis showed a significant difference between the Paxlovid and no-Paxlovid groups in terms of mortality rate (odds ratio [OR] = 0.25; 95% confidence interval [CI]: 0.14-0.45), hospitalization rate (OR = 0.40; 95% CI: 0.24-0.69), polymerase chain reaction negative conversion time (mean difference [MD] = -2.46; 95% CI: -4.31 to -0.61), and hospitalization or death rate (OR = 0.17; 95% CI: 0.06-0.46). However, no significant difference was observed between the two groups in terms of COVID-19 rebound (OR = 0.84; 95% CI: 0.67-1.04), emergency department visit (OR = 0.75; 95% CI: 0.45-1.24), intensive care unit admission (OR = 0.37; 95% CI: 0.13-1.01), and adverse events (OR = 2.20; 95% CI: 0.42-11.47). The results of the present study support the efficacy and safety of Paxlovid in the treatment of patients with COVID-19. Further research is needed to investigate the COVID-19 rebound after Paxlovid treatment.

Keywords: COVID-19; Paxlovid; SARS-CoV-2; nirmatrelvir/ritonavir.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic reviews and Meta‐Analysis flow diagram of the included studies in the meta‐analysis
Figure 2
Figure 2
Forest plot of Paxlovid versus control for mortality rate (A), hospitalization rate (B), hospitalization or death rate (C), PCR negative conversion time (D). CI, confidence interval; PCR, polymerase chain reaction.
Figure 3
Figure 3
Forest plot of Paxlovid versus control for COVID‐19 rebound (A), emergency department visit (B), ICU admission (C). CI, confidence interval; COVID‐19, coronavirus disease 2019; ICU, intensive care unit.
Figure 4
Figure 4
Forest plot of Paxlovid versus control for any adverse events. CI, confidence interval.
See this image and copyright information in PMC

References

    1. Amani B, Amani B, Zareei S, Zareei M. Efficacy and safety of arbidol (umifenovir) in patients with COVID‐19: a systematic review and meta‐analysis. Immun Inflamm Dis. 2021;9(4):1197‐1208. - PMC - PubMed
    1. Elsawah HK, Elsokary MA, Abdallah MS, ElShafie AH. Efficacy and safety of remdesivir in hospitalized Covid‐19 patients: systematic review and meta‐analysis including network meta‐analysis. Rev Med Virol. 2021;31(4):e2187. - PubMed
    1. Amani B, Khanijahani A, Amani B, Hashemi P. Lopinavir/ritonavir for COVID‐19: a systematic review and meta‐analysis. J Pharm Pharm Sci. 2021;24:246‐257. - PubMed
    1. Jayk Bernal A, Gomes da Silva MM, Musungaie DB, et al. Molnupiravir for oral treatment of Covid‐19 in nonhospitalized patients. N Engl J Med. 2022;386(6):509‐520. - PMC - PubMed
    1. Wong CKH, Au ICH, Lau KT, Lau EHY, Cowling BJ, Leung GM. Real‐world effectiveness of molnupiravir and nirmatrelvir/ritonavir against mortality, hospitalization, and in‐hospital outcomes among community‐dwelling, ambulatory COVID‐19 patients during the BA. 2.2 wave in Hong Kong: an observational study. Lancet. 2022;400(10359):1213‐1222. - PMC - PubMed

Supplementary concepts