Nirmatrelvir-Ritonavir for Acute Covid-19 in Patients with Cardiovascular Disease and Post-Acute Sequelae of SARS-CoV-2-Infection
Abstract:
Background: There is limited evidence of association of Nirmatrelvir-ritonavir (NMV-r) and incidence of post-acute sequelae of SARS-CoV-2 infection (PASC) in patients with pre-existing cardiovascular disease (CVD).
Objectives: The objective is to assess the association of NMV-r in non-hospitalized, vaccinated patients with pre-existing CVD and occurrence of PASC.
Methods: We conducted a retrospective-cohort study utilizing the TriNetX research network, including vaccinated patients with pre-existing CVD who developed Covid-19 between Dec 2021-Dec 2022. Two cohorts were created based on NMV-r administration within five days of diagnosis, NMV-r and non-NMV-r cohort. The main outcome was presence of PASC, assessed between 30-90 days and 90-180 days after index Covid-19 infection. After propensity score matching (PSM), both cohorts were compared using t-test and Chi-square (χ2) test for continuous and categorical variables respectively.
Results: 26,953 patients remained in each cohort after PSM. Broadly-defined PASC occurred in 6925 patients (26%) in the NMV-r cohort vs. 8150 patients (30.6%) in the non-NMV-r cohort (OR 0·80 CI 0·76-0·82; p<0·001) from 30-90 days and in 6692 patients (25.1%) as compared to 8910 patients (33.5%) (OR 0·25, CI 0·23-0·29; p<0·001) from 90-180 days. Similarly, narrowly-defined PASC occurred in 5335 patients (20%) in the NMV-r cohort vs. 6271 patients (23.6%) in the non-NMV-r cohort between 30-90 days (OR=0·81, CI 0·78-0·84, p<0·001) and in 5121 patients (19.2%) as compared to 6964 patients (26.1%) (OR=0·67, CI 0·64-0·70, p<0.001) between 90 -180 days.
Conclusion: NMV-r in non-hospitalized vaccinated patients with pre-existing CVD with Covid-19 was associated with a reduction in PASC and healthcare utilization.PDF in folder,
JACC: Advances Editor-in-Chief
Candice K. Silversides, MD, FACC
JACC: Advances CME Editor
Kenneth A. Ellenbogen, MD
Author
Barbara S. Wiggins, PharmD, FACC
Important Dates
Date of Release: June 26, 2024
Term of Approval/Date of CME/MOC Expiration: June 25, 2025