Nirmatrelvir for Vaccinated or Unvaccinated Adult Outpatients with Covid-19
In RCT (n=1296), time to sustained alleviation of all signs /symptoms of Covid-19 did not differ significantly between nirmatrelvir–ritonavir & placebo (12 vs 13 days, respectively, p=0.60), & 5 (0.8%) vs 10 (1.6%), respectively, were hospitalized for Covid-19/died from any cause
Source:
New England Journal of Medicine
SPS commentary:
According to an editorial, the disparate results between this trial and studies supporting the use of other medications may be related to differences in timing (e.g., studies showing benefit initiated treatment within 72 hours after symptom onset), participant characteristics, how symptom amelioration was assessed, SARS-CoV-2 variants (although small-molecule drugs, like nirmatrelvir–ritonavir, that target viral enzymes are expected to be active against all of variants detected so far), or antiviral potency of the medications. It calls for adoption of more standardised trial designs, inclusion criteria, and end points to facilitate comparisons of results.It adds that given broad population immunity to SARS-CoV-2 from widespread infection and vaccination, a deeper understanding of who remains at greatest risk, is needed, as well as better tools to predict the likelihood that severe Covid-19 will develop in a given patient.