Comparison of effectiveness and safety of nirmatrelvir/ritonavir versus sotrovimab for COVID-19: a systematic review and meta-analysis

ABSTRACT

Background

This study aims to compare the effectiveness and safety of nirmatrelvir/ritonavir (Paxlovid) and sotrovimab for coronavirus disease 2019 (COVID-19).

Methods

A search was conducted on PubMed, Cochrane Library, and Web of Science to explore relevant studies from January 2021 to November 2023. The risk of bias in the included studies was assessed using the Cochrane Collaboration’s tool. Data analysis was conducted using the Comprehensive Meta-Analysis software (version 3.0).

Results

Fifteen retrospective studies involving 13, 306 patients were included. The meta-analysis revealed no significant difference between the nirmatrelvir/ritonavir and sotrovimab groups in terms of mortality rate (odds ratio [OR] = 0.62, 95% confidence interval [CI]: 0.28 to 1.38), hospitalization rate (OR = 0.76, 95% CI: 0.48 to 1.22), death or hospitalization rate (OR = 0.75, 95% CI: 0.51 to 1.10), and intensive unit care admission (OR = 1.97, 95% CI: 0.38 to 10.07). In terms of safety, nirmatrelvir/ritonavir was associated with a higher incidence of adverse events (OR = 3.44, 95% CI: 1.29 to 9.17).

Conclusions

The meta-analysis showed that nirmatrelvir/ritonavir and sotrovimab have similar effectiveness in treating COVID-19 patients. However, the certainty of evidence supporting these findings is low. High-quality research is needed to better compare these interventions in COVID-19.

KEYWORDS:

• COVID-19
• SARS-COV-2
• nirmatrelvir/ritonavir
• Paxlovid
• sotrovimab

Acknowledgments

We thank the authors of included studies who graciously provided additional data.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

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

Data availability statement

The Supplementary File for this manuscript includes several components, namely the PRISMA checklist, search strategy details, risk of bias assessment for observational studies, and the GRADE tool.

Author contributions

Conceptualization and project administration: Behnam Amani and Bahman Amani, Literature searching: Behnam Amani and Bahman Amani, Data extraction: Behnam Amani and Bahman Amani, Quality assessment: Behnam Amani and Bahman Amani, Data Analysis: Bahman Amani and Behnam Amani, Writing – original draft: Bahman Amani, Writing – review & editing: Bahman Amani and Behnam Amani.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14787210.2024.2326561.

Additional information

Funding

This paper was not funded.