Early administration of Paxlovid reduces the viral elimination time in patients infected with SARS‐CoV‐2 Omicron variants

Abstract

Early administration of Paxlovid reduces the viral elimination time in patients infected with SARS-CoV-2 Omicron variants To the Editor, Nirmatrelvir/ritonavir (Paxlovid) is an oral antiviral drug that has been shown to reduce the risk of hospitalization, severe COVID-19, and mortality among mild-to-moderate COVID-19 patients who are at risk of developing severe disease. 1,2Paxlovid received emergency use authorization from the Chinese National Medical Products Administration on February 31, 2022.The efficacy and safety of Paxlovid in COVID-19 have been studied in clinical studies. 1-3Further, Fangfang Sun et al. 4 recently reported that early administration of Paxlovid within 5 days since diagnosis is associated with a faster clearance of viral load and a shorter time to viral elimination compared with administration of Paxlovid beyond 5 days in high-risk COVID-19 patients who are immunocompromised.However, limited clinical studies have evaluated the effects of early Paxlovid use in the entire COVID-19 inpatient.In this retrospective cohort study, we analyzed the characteristics and outcomes of patient infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant and evaluated the effect of timing of Paxlovid treatment from patient's symptom onset on the time to viral elimination and hospital stay.Data of 470 patients were obtained from the medical records of patients infected with the SARS-CoV-2 Omicron variant from April 12, 2022 to May 20, 2022.SARS-CoV-2 Omicron variant infection was confirmed by reverse-transcription polymerase chain reaction assay (RT-PCR).Inclusion criteria were mild-to-moderate COVID-19 patients who have at least one comorbidity or condition associated with high risk of progression to severe COVID-19: age 60 years, cigarette smoking, hypertension, diabetes, cardiovascular disease, chronic lung disease, chronic liver disease, chronic kidney disease, malignancy, immunosuppressive disease, neurological disease, and body mass index 30 kg/m. 21The exclusion criteria were as follows: contraindications to use Paxlovid, 1 severe or critical COVID-19, transfer to another hospital, and lack of data.The diagnosis and severity of COVID-19 was in accord with the Diagnosis and Treatment Scheme for COVID-19 released by the National Health Commission of China (9th Edition).Viral clearance was defined as two consecutive negative results (cycle threshold 35 by RT-PCR) at least 24 h apart, according to the Diagnosis and Treatment Scheme for COVID-19 released by the National Health Commission of China (9th Edition). 5Patients who were treated with Paxlovid were administered the drug (300 mg nirmatrelvir and 100 mg ritonavir) every 12 h for 5 days.This study was approved by the Medical Ethics Committee of Shidong Hospital, which is affiliated with the University of Shanghai for Science and Technology.The requirement for individual consent for this retrospective study was waived.Data were shown as number (%) or median (interquartile range).Continuous variables with skewed distribution were analyzed by Kruskal-Wallis test, and categorical variables were analyzed by 2 test to compare the characteristics of three groups.The early

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