Authored by Ann Liu, PhD
Medically reviewed by Dr. Brian Koffman
The Bottom Line:
Nirmatrelvir-ritonavir (Paxlovid) reduced the risk of death among immunocompromised patients who were hospitalized with COVID-19.
Who Performed the Research and Where Was it Presented:
Dr. Guozhang Lin and colleagues from The Chinese University of Hong Kong published their findings in Lancet Rheumatology in November 2024.
Background:
Patients who are immunocompromised, including patients with chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL), are more susceptible to COVID-19. They are also at greater risk of developing severe complications, hospitalization, and death due to COVID-19. Nirmatrelvir–ritonavir (a.k.a. Paxlovid) is an antiviral drug used to treat mild to moderate COVID-19 in patients at high risk of progression to severe COVID-19. This includes patients who are 50+ years of age, patients who are overweight or obese, and patients who have certain health conditions and diseases. While this drug has been shown to have short-term benefits (within 21 days) for immunocompromised patients, less is known about how these patients fare in the long term after receiving nirmatrelvir–ritonavir therapy for COVID-19.
Methods and Participants:
This retrospective study used electronic health record data from the Hong Kong Hospital Authority and the Hong Kong Department of Health. Adult patients who tested positive for COVID-19 and required hospitalization between March 2022 and November 2023 were included. Patients were categorized into four groups based on whether they were immunocompromised and whether they were treated with nirmatrelvir-ritonavir. Patient outcomes were assessed between 21 and 365 days after a positive COVID-19 test.
Results:
- Out of 89,772 patients with positive COVID-19 RT-PCR tests, 39,923 patients were included in the study.
- The median age was 75 years, and the median follow-up time was one year.
- 2217 patients were immunocompromised, and 38% of them received nirmatrelvir-ritonavir.
- 37,706 patients were immunocompetent, and 39% of them received nirmatrelvir-ritonavir.
- Immunocompromised patients who received nirmatrelvir–ritonavir had a significantly lower risk of death.
- Immunocompromised patients who received nirmatrelvir–ritonavir had a significantly lower risk of hospitalization for acute respiratory distress syndrome.
- Nirmatrelvir-ritonavir reduced the risk of hospitalization from all causes in immunocompetent patients but not in immunocompromised patients.
Conclusions:
This study provided some good news for immunocompromised patients. Treatment with nirmatrelvir-ritonavir (Paxlovid) reduced the risk of death among immunocompromised patients hospitalized with COVID-19 and the risk of hospitalization for acute respiratory distress syndrome. Additionally, overall mortality from COVID-19 has decreased over time, and mortality rates in the Omicron era are lower than those with previous COVID-19 variants.
Links and Resources:
The full article by Dr. Lin and colleagues can be found here: Association of nirmatrelvir–ritonavir with post-acute sequelae and mortality among patients who are immunocompromised with COVID-19 in Hong Kong: a retrospective cohort study
