Nirmatrelvir/ritonavir treatment and risk for postacute sequelae of COVID-19 in older Singaporeans.

Nirmatrelvir/ritonavir treatment and risk for postacute sequelae of COVID-19 in older Singaporeans.

Publication date: Jan 01, 2025

Significant heterogeneity has been reported in cohort studies evaluating the impact of early oral antiviral treatment on preventing postacute sequelae after COVID-19. We evaluated the impact of early nirmatrelvir/ritonavir on risk of postacute cardiovascular, neurological, respiratory, and autoimmune diagnoses, as well as postacute symptoms amongst older Singaporeans. National COVID-19 registries and healthcare claims databases were used to construct a retrospective population-based cohort enrolling all Singaporeans aged ≥60 years diagnosed with SARS-CoV-2 infection in primary care during Omicron transmission (18 March 2022-4 August 2023). The cohort was divided into nirmatrelvir/ritonavir-treated and untreated groups. Between-group differences in baseline characteristics were adjusted using overlap weighting. Risks of postacute cardiovascular, neurological, respiratory, and autoimmune diagnoses and postacute symptoms (31-180 days) after SARS-CoV-2 infection were contrasted in treated/untreated groups using competing risks regressions (adjusted for demographics/vaccination status/comorbidities). A total of 188 532 older Singaporeans were included; 5. 8% (10 905/188 532) received nirmatrelvir/ritonavir. No significantly decreased risk of postacute sequelae (any sequelae: adjusted hazards ratio [aHR], 1. 06; 0. 94-1. 19; cardiovascular sequelae: aHR, 1. 01; 0. 83-1. 24; neurological sequelae: aHR, 1. 09; 0. 95-1. 27; respiratory sequelae: aHR, 1. 14; 0. 84-1. 55; autoimmune sequelae: aHR, 0. 76; 0. 53-1. 09; or any postacute symptom: aHR, 0. 97; 0. 80-1. 18) was observed up to 180 days post-infection in nirmatrelvir/ritonavir-treated individuals vs. untreated cases. Across all vaccination and age subgroups, no significantly decreased risk of any postacute diagnosis/symptom or any cardiovascular, neurological, respiratory, and autoimmune complications up to 180 days post-infection was observed. Early outpatient receipt of nirmatrelvir/ritonavir did not significantly reduce risk of postacute cardiovascular, neurological, respiratory, and autoimmune sequelae or the risk of postacute symptoms in a boosted cohort of older Singaporeans.

Concepts Keywords
Competing Aged
Outpatient Aged, 80 and over
Singaporeans Antiviral Agents
Antiviral Agents
Cardiovascular Diseases
COVID-19
COVID-19
COVID-19 Drug Treatment
Drug Combinations
Drug Combinations
Female
Humans
Long COVID
Lopinavir
Lopinavir
lopinavir-ritonavir drug combination
Male
Middle Aged
Nirmatrelvir-ritonavir
Omicron
Retrospective Studies
Risk Factors
Ritonavir
Ritonavir
SARS-CoV-2
SARS-CoV-2
Singapore
Southeast Asian People

Semantics

Type Source Name
drug DRUGBANK Ritonavir
disease MESH sequelae
disease MESH COVID-19
pathway REACTOME SARS-CoV-2 Infection
disease IDO symptom
disease MESH infection
disease MESH Long Covid
disease MESH Cardiovascular Diseases
drug DRUGBANK Lopinavir

Original Article

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