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Review
. 2023 Sep;33(5):e2473.
doi: 10.1002/rmv.2473. Epub 2023 Jul 23.

Efficacy and safety of paxlovid (nirmatrelvir/ritonavir) in the treatment of COVID-19: An updated meta-analysis and trial sequential analysis

Haokun Tian  1   2   3 , Changsen Yang  1   2   3 , Tiangang Song  1   2   3 , Kechen Zhou  1   2   3 , Lequan Wen  1   2   3 , Ye Tian  1   2   3 , Lirui Tang  1   2   3 , Weikai Xu  1   2   3 , Xinyuan Zhang  1   2   3
Affiliations
Review

Efficacy and safety of paxlovid (nirmatrelvir/ritonavir) in the treatment of COVID-19: An updated meta-analysis and trial sequential analysis

Haokun Tian et al. Rev Med Virol. 2023 Sep.

Abstract

Our study is aimed to access the efficacy and safety outcomes for coronavirus disease 2019 (COVID-19) patients treated with Paxlovid. According to inclusion and exclusion criteria, databases were used to retrieve articles from 1 January 2020 to 1 January 2023. Article screening, quality evaluation and data extraction were completed and cross-checked. The meta-analysis and trial sequential analysis (TSA) were conducted using RevMan, StataMP, and TSA software. A total of 42 original articles were included. Overall meta-analysis results showed that for death, hospitalisation, death or hospitalisation, emergency department (ED) visit, intensive care unit (ICU) admission, and extra oxygen requirement outcomes, every odds ratio (OR) was <1 and p < 0.05. For rebound outcome, the OR was >1 and p > 0.05. For adverse events (AEs) outcome, the OR was >1 and p < 0.05. In conclusion, Paxlovid effectively reduced the risks of death, hospitalisation, death or hospitalisation, ED visit, ICU admission, and extra oxygen requirement. There was no significant statistical difference considering rebound, but people should pay attention to possible AEs. However, for rebound and AEs outcomes, observations in certain subgroups suggested conclusions contrary to the overall meta-analysis. Trial sequential analysis indicated these two outcomes have a risk of false negative or false positive conclusions, so additional original studies are needed for further validation.

Keywords: COVID-19; efficacy; nirmatrelvir; paxlovid; ritonavir; safety.

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References

REFERENCES

    1. Forchette L, Sebastian W, Liu T. A comprehensive review of COVID-19 virology, vaccines, variants, and therapeutics. Curr Med Sci. 2021;41(6):1037-1051. https://doi.org/10.1007/s11596-021-2395-1
    1. Rahman S, Montero MTV, Rowe K, Kirton R, Kunik F. Epidemiology, pathogenesis, clinical presentations, diagnosis and treatment of COVID-19: a review of current evidence. Expert Rev Clin Pharmacol. 2021;14(5):601-621. https://doi.org/10.1080/17512433.2021.1902303
    1. Marzi M, Vakil MK, Bahmanyar M, Zarenezhad E. Paxlovid: mechanism of action, synthesis, and study. BioMed Res Int. 2022;2022:7341493. https://doi.org/10.1155/2022/7341493
    1. Lamb YN. Nirmatrelvir plus ritonavir: first approval. Drugs. 2022;82(5):585-591. https://doi.org/10.1007/s40265-022-01692-5
    1. Owen DR, Allerton CMN, Anderson AS, et al. An oral SARS-CoV-2 M inhibitor clinical candidate for the treatment of COVID-19. Science. 2021;374(6575):1586-1593. https://doi.org/10.1126/science.abl4784