Clinical effectiveness of nirmatrelvir plus ritonavir in the treatment of COVID-19 in patients with cirrhosis

ABSTRACT

Objectives

This retrospective cohort study assessed the clinical effectiveness of nirmatrelvirplus ritonavir (NMV-r) in treating COVID-19 in patients with liver cirrhosis(LC).

Methods

The data of non-hospitalized adult patients with LC who had COVID-19 were selected from the TriNetX platform for the period between 1 March 20201 March 2020, and 31 December 202231 December 2022. Propensity score matching was used to match patients receiving NMV-r (theNMV-r group) with those not receiving NMV-r (the control group). Hazard ratios(HRs) along with 95% confidence intervals (CIs) for the primary outcome – a composite of all-cause hospitalization or mortality during the 30-day follow-up period – were calculated and compared.

Results

Two cohorts of 2,369 patients each with balanced baseline characteristics were identified.During the follow-up period, the NMV-r group had a lower risk of all-cause hospitalization or mortality (HR, 0.642;95% CI, 0.503–0.819) than did the control group.NMV-r was also associated with a reduced risk of individual all-cause hospitalization (HR 0.681, 95% CI 0.530–0.876])and all-cause mortality (HR, 0.270; 95% CI,0.129–0.562). This association was consistently observed in the subgroups of age, sex, vaccination status, and LC severity.

Conclusions

NMV-r can reduce all-cause hospitalization and mortality among patients with LC who have COVID-19.

KEYWORDS:

• COVID-19
• liver cirrhosis
• nirmatrelvir
• ritonavir
• SARS-CoV-2

Abbreviations

CLD	=	chronic liver disease
COVID-19	=	coronavirus disease 2019
HCO	=	health-care organization
NMV-r	=	nirmatrelvir plus ritonavir
LC	=	liver cirrhosis
SARS-CoV-2	=	severe acute respiratory syndrome coronavirus 2

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or material discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contribution statement

The authors have substantially contributed to the conception and design of this article as well as the interpretation of relevant literature. In addition, the authors have been involved in writing the article and revising it for intellectual content.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14787210.2023.2267846.

Additional information

Funding

This paper was not funded.