Evidence map›Paper›PMID 36781188›Full record

Trial reportCMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne2023

Population-based evaluation of the effectiveness of nirmatrelvir-ritonavir for reducing hospital admissions and mortality from COVID-19.

Kevin L Schwartz, Jun Wang, Mina Tadrous, Bradley J Langford, Nick Daneman, Valerie Leung, Tara Gomes, Lindsay Friedman, Peter Daley, Kevin A Brown

Open access · goldAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
42citing papers in PubMed, 5 pooled it
17.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

42 citing papers in PubMed, 5 syntheses or guidelines pooled it, 90 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Trial
  7. Article
  8. Article
  9. Article
  10. Review
  11. Article
  12. Article
  13. Article
  14. Article
  15. Review
  16. Article
  17. Article
  18. Article
  19. Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 6 institutions in 3 countries.

Kevin L SchwartzPublic Health Ontario (Schwartz, Wang, Langford, Daneman, Leung, Friedman, Brown); ICES Central (Schwartz, Wang, Tadrous, Daneman, Gomes, Brown); Leslie Dan Faculty of Pharmacy (Tadrous, Gomes) and Dalla Lana School of Public Health (Langford, Brown, Schwartz), University of Toronto; Toronto East Health Network (Leung); Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gomes); Sunnybrook Health Sciences Centre (Daneman), Toronto, Ont.; Memorial University (Daley), St. John's, NL Kevin.schwartz@oahpp.ca.
Jun WangPublic Health Ontario (Schwartz, Wang, Langford, Daneman, Leung, Friedman, Brown); ICES Central (Schwartz, Wang, Tadrous, Daneman, Gomes, Brown); Leslie Dan Faculty of Pharmacy (Tadrous, Gomes) and Dalla Lana School of Public Health (Langford, Brown, Schwartz), University of Toronto; Toronto East Health Network (Leung); Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gomes); Sunnybrook Health Sciences Centre (Daneman), Toronto, Ont.; Memorial University (Daley), St. John's, NL.
Mina TadrousPublic Health Ontario (Schwartz, Wang, Langford, Daneman, Leung, Friedman, Brown); ICES Central (Schwartz, Wang, Tadrous, Daneman, Gomes, Brown); Leslie Dan Faculty of Pharmacy (Tadrous, Gomes) and Dalla Lana School of Public Health (Langford, Brown, Schwartz), University of Toronto; Toronto East Health Network (Leung); Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gomes); Sunnybrook Health Sciences Centre (Daneman), Toronto, Ont.; Memorial University (Daley), St. John's, NL.
Bradley J LangfordPublic Health Ontario (Schwartz, Wang, Langford, Daneman, Leung, Friedman, Brown); ICES Central (Schwartz, Wang, Tadrous, Daneman, Gomes, Brown); Leslie Dan Faculty of Pharmacy (Tadrous, Gomes) and Dalla Lana School of Public Health (Langford, Brown, Schwartz), University of Toronto; Toronto East Health Network (Leung); Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gomes); Sunnybrook Health Sciences Centre (Daneman), Toronto, Ont.; Memorial University (Daley), St. John's, NL.
Nick DanemanPublic Health Ontario (Schwartz, Wang, Langford, Daneman, Leung, Friedman, Brown); ICES Central (Schwartz, Wang, Tadrous, Daneman, Gomes, Brown); Leslie Dan Faculty of Pharmacy (Tadrous, Gomes) and Dalla Lana School of Public Health (Langford, Brown, Schwartz), University of Toronto; Toronto East Health Network (Leung); Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gomes); Sunnybrook Health Sciences Centre (Daneman), Toronto, Ont.; Memorial University (Daley), St. John's, NL.
Valerie LeungPublic Health Ontario (Schwartz, Wang, Langford, Daneman, Leung, Friedman, Brown); ICES Central (Schwartz, Wang, Tadrous, Daneman, Gomes, Brown); Leslie Dan Faculty of Pharmacy (Tadrous, Gomes) and Dalla Lana School of Public Health (Langford, Brown, Schwartz), University of Toronto; Toronto East Health Network (Leung); Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gomes); Sunnybrook Health Sciences Centre (Daneman), Toronto, Ont.; Memorial University (Daley), St. John's, NL.
Tara GomesPublic Health Ontario (Schwartz, Wang, Langford, Daneman, Leung, Friedman, Brown); ICES Central (Schwartz, Wang, Tadrous, Daneman, Gomes, Brown); Leslie Dan Faculty of Pharmacy (Tadrous, Gomes) and Dalla Lana School of Public Health (Langford, Brown, Schwartz), University of Toronto; Toronto East Health Network (Leung); Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gomes); Sunnybrook Health Sciences Centre (Daneman), Toronto, Ont.; Memorial University (Daley), St. John's, NL.
Lindsay FriedmanPublic Health Ontario (Schwartz, Wang, Langford, Daneman, Leung, Friedman, Brown); ICES Central (Schwartz, Wang, Tadrous, Daneman, Gomes, Brown); Leslie Dan Faculty of Pharmacy (Tadrous, Gomes) and Dalla Lana School of Public Health (Langford, Brown, Schwartz), University of Toronto; Toronto East Health Network (Leung); Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gomes); Sunnybrook Health Sciences Centre (Daneman), Toronto, Ont.; Memorial University (Daley), St. John's, NL.
Peter DaleyPublic Health Ontario (Schwartz, Wang, Langford, Daneman, Leung, Friedman, Brown); ICES Central (Schwartz, Wang, Tadrous, Daneman, Gomes, Brown); Leslie Dan Faculty of Pharmacy (Tadrous, Gomes) and Dalla Lana School of Public Health (Langford, Brown, Schwartz), University of Toronto; Toronto East Health Network (Leung); Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gomes); Sunnybrook Health Sciences Centre (Daneman), Toronto, Ont.; Memorial University (Daley), St. John's, NL.
Kevin A BrownPublic Health Ontario (Schwartz, Wang, Langford, Daneman, Leung, Friedman, Brown); ICES Central (Schwartz, Wang, Tadrous, Daneman, Gomes, Brown); Leslie Dan Faculty of Pharmacy (Tadrous, Gomes) and Dalla Lana School of Public Health (Langford, Brown, Schwartz), University of Toronto; Toronto East Health Network (Leung); Li Ka Shing Knowledge Institute of St. Michael's Hospital (Gomes); Sunnybrook Health Sciences Centre (Daneman), Toronto, Ont.; Memorial University (Daley), St. John's, NL.
3M (United States) · USPublic Health Ontario · CASt. Michael's Hospital · CASunnybrook Health Science Centre · CAHealth Net · USSt Michaels Hospital · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundA randomized controlled trial involving a high-risk, unvaccinated population that was conducted before the Omicron variant emerged found that nirmatrelvir-ritonavir was effective in preventing progression to severe COVID-19. Our objective was to evaluate the effectiveness of nirmatrelvir-ritonavir in preventing severe COVID-19 while Omicron and its subvariants predominate.

methodsWe conducted a population-based cohort study in Ontario that included all residents who were older than 17 years of age and had a positive polymerase chain reaction test for SARS-CoV-2 between Apr. 4 and Aug. 31, 2022. We compared patients treated with nirmatrelvir-ritonavir with patients who were not treated and measured the primary outcome of hospital admission from COVID-19 or all-cause death at 1-30 days, and a secondary outcome of all-cause death. We used weighted logistic regression to calculate weighted odds ratios (ORs) with confidence intervals (CIs) using inverse probability of treatment weighting (IPTW) to control for confounding.

resultsThe final cohort included 177 545 patients, 8876 (5.0%) who were treated with nirmatrelvir-ritonavir and 168 669 (95.0%) who were not treated. The groups were well balanced with respect to demographic and clinical characteristics after applying stabilized IPTW. We found that the occurrence of hospital admission or death was lower in the group given nirmatrelvir-ritonavir than in those who were not (2.1% v. 3.7%; weighted OR 0.56, 95% CI 0.47-0.67). For death alone, the weighted OR was 0.49 (95% CI 0.39-0.62). Our findings were similar across strata of age, drug-drug interactions, vaccination status and comorbidities. The number needed to treat to prevent 1 case of severe COVID-19 was 62 (95% CI 43-80), which varied across strata.

interpretationNirmatrelvir-ritonavir was associated with significantly reduced odds of hospital admission and death from COVID-19, which supports use to treat patients with mild COVID-19 who are at risk for severe disease.

Indexed as

COVID-19Antiviral AgentsCohort StudiesCOVID-19 Drug TreatmentHospitalsHumansLactamsLeucineNitrilesProlineRitonavirSARS-CoV-2Antiviral AgentsLactamsLeucinenirmatrelvirNitrilesProlineRitonavir

Identifiers

PMID36781188
PMCPMC9928441
OpenAlexW4320495180

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.