口服抗病毒药物的使用对社区新型冠状病毒病 2019 患者（COVID-19）住院风险的影响。
Impact of the Use of Oral Antiviral Agents on the Risk of Hospitalization in Community Coronavirus Disease 2019 Patients (COVID-19).
机构信息
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
Department of Medicine and Therapeutics, Medical Data Analytics Centre (MDAC), The Chinese University of Hong Kong, Hong Kong, China.
出版信息
Clin Infect Dis. 2023 Feb 8;76(3):e26-e33. doi: 10.1093/cid/ciac687.
BACKGROUND
We examined the effectiveness of molnupiravir and nirmatrelvir/ritonavir in reducing hospitalization and deaths in a real-world cohort of nonhospitalized patients with coronavirus disease 2019 (COVID-19).
METHODS
This was a territory-wide retrospective cohort study in Hong Kong. Nonhospitalized 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%), 5808 (6.2%), and 4921 (5.2%) were oral antiviral nonusers, molnupiravir users, and nirmatrelvir/ritonavir users, respectively. Compared with nonusers, 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, 1931 (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% confidence interval [CI], 0.65-0.95; P = .011) but not molnupiravir use (weighted hazard ratio 1.17; 95% CI, 0.99-1.39; P = .062) was associated with a reduced risk of hospitalization than nonusers. The use of molnupiravir or nirmatrelvir/ritonavir was not associated with a lower risk of the secondary endpoint as compared with nonusers.
CONCLUSION
Use of nirmatrelvir/ritonavir but not molnupiravir was associated with a reduced risk of hospitalization in real-world nonhospitalized patients with COVID-19.
背景
我们研究了莫努匹韦和奈玛特韦/利托那韦在降低新冠肺炎（COVID-19）非住院患者住院和死亡方面的有效性。
方法
这是一项在香港进行的全港回顾性队列研究。我们确定了 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。排除了在首次就诊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。次要终点是入住重症监护病房、使用有创机械通气和/或死亡的复合终点。
结果
在 93883 名患者中，分别有 83154（88.6%）、5808（6.2%）和 4921（5.2%）例患者未使用口服抗病毒药物、使用莫努匹韦和使用奈玛特韦/利托那韦。与未使用者相比，口服抗病毒药物使用者年龄较大，合并症更多，完全疫苗接种率更低，且前一年的住院率更高。与使用奈玛特韦/利托那韦相比，使用莫努匹韦的患者年龄更大，合并症更多，完全疫苗接种率更低，且前一年的住院率更高。中位随访 30 天内，有 1931（2.1%）例患者住院，225（0.2%）例患者发生次要终点事件。经倾向评分加权后，与未使用者相比，使用奈玛特韦/利托那韦（加权风险比 0.79；95%置信区间[CI]，0.65-0.95；P =.011）而不是莫努匹韦（加权风险比 1.17；95% CI，0.99-1.39；P =.062）与降低住院风险相关。与未使用者相比，使用莫努匹韦或奈玛特韦/利托那韦与降低次要终点风险无关。
结论
在现实世界中，与未使用者相比，使用奈玛特韦/利托那韦而非莫努匹韦与 COVID-19 非住院患者的住院风险降低相关。
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