Predictors of nirmatrelvir-ritonavir receipt among COVID-19 patients in a large US health system.

Publication date: Mar 29, 2024

A clear understanding of real-world uptake of nirmatrelvir-ritonavir for treatment of SARS-CoV-2 can inform treatment allocation strategies and improve interpretation of effectiveness studies. We used data from a large US healthcare system to describe nirmatrelvir-ritonavir dispenses among all SARS-CoV-2 positive patients aged ≥ 12 years meeting recommended National Institutes of Health treatment eligibility criteria for the study period between 1 January and 31 December, 2022. Overall, 10. 9% (N = 34,791/319,900) of treatment eligible patients with SARS-CoV-2 infections received nirmatrelvir-ritonavir over the study period. Although uptake of nirmatrelvir-ritonavir increased over time, by the end of 2022, less than a quarter of treatment eligible patients with SARS-CoV-2 infections had received nirmatrelvir-ritonavir. Across patient demographics, treatment was generally consistent with tiered treatment guidelines, with dispenses concentrated among patients aged ≥ 65 years (14,706/63,921; 23. 0%), and with multiple comorbidities (10,989/54,431; 20. 1%). However, neighborhoods of lower socioeconomic status (upper third of neighborhood deprivation index [NDI]) had between 12% (95% CI: 7-18%) and 28% (25-32%) lower odds of treatment dispense over the time periods studied compared to the lower third of NDI distribution, even after accounting for demographic and clinical characteristics. A limited chart review (N = 40) confirmed that in some cases a decision not to treat was appropriate and aligned with national guidelines to use clinical judgement on a case-by-case basis. There is a need to enhance patient and provider awareness on the availability and benefits of nirmatrelvir-ritonavir for the treatment of COVID-19 illness.

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Concepts Keywords
Healthcare Cov
Socioeconomic Covid


Type Source Name
drug DRUGBANK Ritonavir
disease MESH COVID-19
disease VO effectiveness
disease VO time
drug DRUGBANK Coenzyme M
disease MESH infections
disease IDO symptom
disease VO effective
disease MESH death
disease MESH Emergency
disease VO vaccination
disease VO population
disease VO USA
disease MESH Infectious Diseases
disease VO Gap
disease MESH drug interactions
disease MESH obesity
disease MESH sore throat
drug DRUGBANK Aspartame
disease MESH comorbidity
drug DRUGBANK Methionine
disease MESH chronic condition
disease VO dose
disease VO age
disease MESH Heart failure
disease MESH Stroke
disease MESH COPD
disease VO unvaccinated
drug DRUGBANK Pentaerythritol tetranitrate
disease MESH morbidities
disease IDO algorithm
disease IDO infection
disease VO vaccinated
disease VO report
disease MESH lifestyles
pathway REACTOME Translation
drug DRUGBANK Gold
disease MESH social vulnerability

Original Article

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