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. 2023 Dec;62(6):106984.
doi: 10.1016/j.ijantimicag.2023.106984. Epub 2023 Sep 26.

Association between nirmatrelvir plus ritonavir and the outcomes of non-hospitalized obese patients with COVID-19

Jheng-Yan Wu  1 , Mei-Yuan Liu  2 , Ting-Hui Liu  3 , Min-Hsiang Chuang  4 , Wan-Hsuan Hsu  3 , Po-Yu Huang  4 , Ya-Wen Tsai  5 , Chih-Cheng Lai  6
Affiliations

Association between nirmatrelvir plus ritonavir and the outcomes of non-hospitalized obese patients with COVID-19

Jheng-Yan Wu et al. Int J Antimicrob Agents. 2023 Dec.

Abstract

Objective: To investigate the association between nirmatrelvir plus ritonavir (NMV-r) and the outcomes of non-hospitalized obese patients with coronavirus disease 2019 (COVID-19).

Methods: This retrospective cohort study used the TriNetX research network to identify non-hospitalized obese adult patients with COVID-19 between 1 January 2022 and 30 June 2023. Propensity score matching was used to match patients receiving NMV-r (NMV-r group) with those not receiving NMV-r (control group). The primary outcome was the compositive outcome of all-cause emergency department (ED) visits, hospitalization or death during the 30-day follow-up period.

Results: Using propensity score matching methods, two cohorts of 30,969 patients each with balanced baseline characteristics were identified. During the follow-up period, the NMV-r group had a lower risk of all-cause ED visits, hospitalization or death [4.80% (n=1489) vs 5.50% (n=1705); hazard ratio (HR) 0.900, 95% confidence interval (CI) 0.839-0.965]. Compared with the control group, the NMV-r group had a lower risk of all-cause ED visits (HR 0.812, 95% CI 0.740-0.891) and all-cause mortality (HR 0.089, 95% CI 0.027-0.288). The lower risk in the NMV-r group compared with the control group was observed consistently in most subgroup analyses according to body mass index (30.0-34.9 kg/m2: HR 0.68, 95% CI 0.55-0.82; 35.0-39.9 kg/m2: HR 0.67, 95% CI 0.52-0.87), age (4-64 years: HR 0.83, 95% CI 0.75-0.92; ≥65 years: HR 0.88, 95% CI 0.79-0.98), sex (men: HR 0.69, 95% CI 0.60-0.79; women: HR 0.69, 95% CI 0.63-0.76) and vaccination status (unvaccinated: HR 0.75, 95% CI 0.70-0.81).

Conclusion: NMV-r is associated with reduced risk of all-cause ED visits, hospitalization and death for non-hospitalized obese patients with COVID-19. Accordingly, these findings support the use of NMV-r in obese patients.

Keywords: COVID-19; Emergency department; Hospitalization; Mortality; Nirmatrelvir plus ritonavir; Obese; SARS-CoV-2.

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