Nirmatrelvir/Ritonavir (Paxlovid) Use Among Individuals at Risk of Severe COVID-19: An Analysis of the National COVID Cohort Collaborative (N3C).

IF 2.4 4区医学 Q3 PHARMACOLOGY & PHARMACY Pharmacoepidemiology and Drug Safety Pub Date : 2024-08-01 DOI:10.1002/pds.5869

Xuya Xiao, G Caleb Alexander, Hemalkumar B Mehta

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Abstract

Purpose: Paxlovid is effective in reducing COVID-19 hospitalization and mortality. This study characterized Paxlovid use and evaluated racial/ethnic disparities over time among community-dwelling adults at high risk of progression to severe COVID-19 disease.

Methods: This retrospective cohort study used the National COVID Cohort Collaborative (N3C) data and included individuals aged 18 years or older diagnosed with COVID-19 between January 2022 and December 2023. The study cohort included nonhospitalized individuals who were at high risk of COVID-19 progression, and selected the first COVID-19 episode in each quarter, including reinfection episodes. Paxlovid use was defined as receiving Paxlovid within ±5 days of a COVID-19 diagnosis. We used descriptive statistics to characterize Paxlovid use overall and by calendar quarter and race/ethnicity. We used a generalized estimating equations (GEE) models to quantify the association of race/ethnicity with Paxlovid use controlling for age, gender, and clinical characteristics.

Results: Among 1 264 215 individuals at high risk of disease progression (1 404 607 episodes), Paxlovid use increased from 1.2% in January-March 2022 to 35.1% in October-December 2023. Paxlovid use was more common among non-Hispanic White individuals (23.9%) than non-Hispanic Black (16.5%) and Latinx/e (16.7%) patients. After adjusting age, gender, and clinical characteristics, Paxlovid use was less likely among non-Hispanic Black (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.68-0.70) and Latinx/e (OR 0.72, CI 0.71-0.73) patients than non-Hispanic White patients.

Conclusions: Among a large, diverse cohort of community-dwelling individuals with COVID-19, nearly two out of three eligible individuals did not receive Paxlovid, and minoritized racial/ethnic groups were less likely to use Paxlovid than their non-Hispanic White individuals.

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严重 COVID-19 高危人群中 Nirmatrelvir/Ritonavir (Paxlovid) 的使用情况：国家 COVID 队列协作组织 (N3C) 分析。

目的：Paxlovid 能有效降低 COVID-19 的住院率和死亡率。本研究描述了Paxlovid的使用情况，并评估了社区成人中COVID-19病情恶化的高危人群在不同时期的种族/族裔差异：这项回顾性队列研究使用了全国COVID队列协作组织（N3C）的数据，纳入了2022年1月至2023年12月期间确诊为COVID-19的18岁或18岁以上的患者。研究队列包括COVID-19进展高风险的非住院患者，并选择了每个季度的首次COVID-19发作，包括再感染发作。Paxlovid的使用定义为在COVID-19确诊后±5天内接受Paxlovid治疗。我们使用描述性统计来描述 Paxlovid 的总体使用情况，并按日历季度和种族/人种进行分类。在控制年龄、性别和临床特征的前提下，我们使用广义估计方程（GEE）模型来量化种族/人种与使用 Paxlovid 的关系：在1 264 215名疾病进展高危人群（1 404 607次发病）中，Paxlovid的使用率从2022年1月至3月的1.2%增至2023年10月至12月的35.1%。非西班牙裔白人（23.9%）比非西班牙裔黑人（16.5%）和拉丁裔/e 族（16.7%）患者更常使用 Paxlovid。在对年龄、性别和临床特征进行调整后，非西班牙裔黑人（几率比[OR]0.69，95%置信区间[CI]0.68-0.70）和拉丁裔/e（OR 0.72，CI 0.71-0.73）患者使用 Paxlovid 的可能性低于非西班牙裔白人患者：结论：在一大批居住在社区的 COVID-19 患者中，有近三分之二符合条件的患者没有接受 Paxlovid 治疗，少数种族/族裔群体使用 Paxlovid 的可能性低于非西班牙裔白人患者。

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来源期刊

Pharmacoepidemiology and Drug Safety 医学-药学

CiteScore

4.80

自引率

7.70%

发文量

173

审稿时长

3 months

期刊介绍： The aim of Pharmacoepidemiology and Drug Safety is to provide an international forum for the communication and evaluation of data, methods and opinion in the discipline of pharmacoepidemiology. The Journal publishes peer-reviewed reports of original research, invited reviews and a variety of guest editorials and commentaries embracing scientific, medical, statistical, legal and economic aspects of pharmacoepidemiology and post-marketing surveillance of drug safety. Appropriate material in these categories may also be considered for publication as a Brief Report. Particular areas of interest include: design, analysis, results, and interpretation of studies looking at the benefit or safety of specific pharmaceuticals, biologics, or medical devices, including studies in pharmacovigilance, postmarketing surveillance, pharmacoeconomics, patient safety, molecular pharmacoepidemiology, or any other study within the broad field of pharmacoepidemiology; comparative effectiveness research relating to pharmaceuticals, biologics, and medical devices. Comparative effectiveness research is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition, as these methods are truly used in the real world; methodologic contributions of relevance to pharmacoepidemiology, whether original contributions, reviews of existing methods, or tutorials for how to apply the methods of pharmacoepidemiology; assessments of harm versus benefit in drug therapy; patterns of drug utilization; relationships between pharmacoepidemiology and the formulation and interpretation of regulatory guidelines; evaluations of risk management plans and programmes relating to pharmaceuticals, biologics and medical devices.