Clinical effectiveness of nirmatrelvir plus ritonavir for patients with COVID-19 and preexisting psychiatric disorders

ABSTRACT

Objectives

This study assessed the clinical effectiveness of the combination of nirmatrelvir and ritonavir (NMV-r) in treating nonhospitalized patients with COVID-19 who have preexisting psychiatric disorders.

Methods

Patients diagnosed with COVID-19 and psychiatric disorders between 1 March 2020, and 1 December 2022, were included using the TriNetX network. The primary outcome was the composite outcome of all-cause emergency department (ED) visits, hospitalization, or death within 30 days.

Results

Propensity score matching yielded two cohorts of 20,633 patients each. The composite outcome of all-cause ED visits, hospitalization, or death within 30 days was 3.57% (737 patients) in the NMV-r cohort and 5.69% (1176) in the control cohort, resulting in a reduced risk in the NMV-r cohort (HR: 0.657; 95% confidence interval (CI): 0.599–0.720). The NMV-r cohort exhibited a lower risk of all-cause hospitalization (HR: 0.385; 95% CI: 0.328–0.451) and all-cause death (HR: 0.110; 95% CI: 0.053–0.228) compared with the control group.

Conclusion

NMV-r could mitigate the risk of adverse outcomes in nonhospitalized patients with COVID-19 and preexisting psychiatric disorders. However, only a limited number of patients in this population received adequate treatment, thus emphasizing the importance of promoting its appropriate use.

KEYWORDS:

• COVID-19
• hospitalization
• mortality
• nirmatrelvir plus ritonavir
• psychiatric disorders, psychotic disorders
• anxiety disorder
• mood disorders
• SARS-CoV-2

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.

Ethics statement

This study was approved by the Institutional Review Board of Chi Mei Medical Center (No. 11202–002).

Data availability statement

The datasets generated or analyzed during the current study are available from the corresponding author upon reasonable request.

Author contributions

Ting-Hui Liu contributed the idea, designed the study, and did the primary writing. Jheng-Yan Wu, Po-Yu Huang, Wan-Hsuan Hsu, and Min-Hsiang Chuang were responsible for statistics and methodology. Ya-Wen Tsai provided expertise in databases. Chih-Cheng Lai and Charles Lung-Cheng Huang supervised and revised the article.

Supplemental data

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14787210.2024.2351555.

Additional information

Funding

This paper was not funded.