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Real-world nirmatrelvir-ritonavir outpatient treatment in reducing hospitalization for high-risk patients with COVID-19 during Omicron BA.4, BA.5 and XBB subvariants dominance in Malaysia: A retrospective cohort study

Low EV 1 , Pathmanathan MD 2 , Chidambaram SK 3 , Kim WR 4 , Lee WJ 5 , Teh ZW 5 Show all authors , Appannan MR 5 , Zin SM 6 , Zin FM 6 , Amin SBM 6 , Ismail M 7 , Samad AA 8 , Peariasamy KM 2

Affiliations 

  • 1 Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, No.1 Jalan Setia Murni U13/52, Seksyen U13, 40170 Shah Alam, Selangor, Malaysia. Electronic address: evlow@moh.gov.my
  • 2 Institute for Clinical Research, National Institutes of Health, Ministry of Health Malaysia, No.1 Jalan Setia Murni U13/52, Seksyen U13, 40170 Shah Alam, Selangor, Malaysia
  • 3 Department of Medicine, Sungai Buloh Hospital, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
  • 4 Digital Public Health Division (interim), Ministry of Health Malaysia, Blok F1, Complex F, 62000 Wilayah Persekutuan Putrajaya, Malaysia; Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, No.1 Jalan Setia Murni U13/52, Seksyen U13, 40170 Shah Alam, Selangor, Malaysia
  • 5 Digital Public Health Division (interim), Ministry of Health Malaysia, Blok F1, Complex F, 62000 Wilayah Persekutuan Putrajaya, Malaysia
  • 6 Medical Development Division, Ministry of Health Malaysia, Block E1, Complex E, 62590 Wilayah Persekutuan Putrajaya, Malaysia
  • 7 Family Health Development Division, Ministry of Health Malaysia, Block E10, Complex E, 62590 Wilayah Persekutuan Putrajaya, Malaysia
  • 8 Section 7 Health Clinic, No.2 Persiaran Kayangan, Seksyen 7, 40000 Shah Alam, Selangor, Malaysia
Int J Infect Dis, 2023 Oct;135:77-83.
PMID: 37567557 DOI: 10.1016/j.ijid.2023.08.003

Abstract

OBJECTIVE: To determine if nirmatrelvir-ritonavir 300mg/100mg treatment for 5 days in high-risk outpatients with mild to moderate COVID-19 symptoms was associated with a reduction in hospitalization, intensive care unit (ICU) admission, and death.

METHODS: This 1:1 propensity score matched cohort study from 647 public health clinics in Malaysia included all patients with COVID-19 with positive tests aged 18 years and older, who were eligible for nirmatrelvir-ritonavir treatment within 5 days of illness from July 14, 2022, to November 14, 2022. The exposed group was patients with COVID-19 initiated with nirmatrelvir-ritonavir treatment, whereas those not initiated with the drug served as the control group. Data was analyzed from July 14, 2022 to December 31, 2022.

RESULTS: A total of 20,966 COVID-19 high-risk outpatients (n = 10,483 for nirmatrelvir-ritonavir group and n = 10,483 for control group) were included in the study. Nirmatrelvir-ritonavir treatment was associated with a 36% reduction (adjusted hazard ratio 0.64 [95% CI 0.43, 0.94]) in hospitalization compared with those not given the drug. There was a single ICU admission for the control group and one death each was reported in the nirmatrelvir-ritonavir and control group, respectively.

CONCLUSIONS: Nirmatrelvir-ritonavir treatment was associated with reduced hospitalization in high-risk patients with COVID-19 even in highly vaccinated populations.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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