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

IF 10.9 1区医学 Q1 INFECTIOUS DISEASES Clinical Microbiology and Infection Pub Date : 2024-08-28 DOI:10.1016/j.cmi.2024.08.019

Liang En Wee, Jue Tao Lim, An Ting Tay, Calvin J Chiew, Barnaby Edward Young, Betty Wong, Ruth Lim, Ching Li Lee, Joyce Tan, Shawn Vasoo, David Chien Lye, Kelvin Bryan Tan

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Abstract

Objectives: Significant heterogeneity has been reported in cohort studies evaluating the impact of early oral antiviral treatment on preventing post-acute sequelae after COVID-19 (PASC). We evaluated the impact of early nirmatrelvir/ritonavir on risk of post-acute cardiovascular, neurological, respiratory and autoimmune diagnoses, as well as post-acute symptoms amongst older Singaporeans.

Methods: National COVID-19 registries and healthcare claims databases were utilized to construct a retrospective population-based cohort enrolling all Singaporeans aged≥60 years diagnosed with SARS-CoV-2 infection at primary care during Omicron transmission (18th March 2022-4th 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 post-acute cardiovascular, neurological, respiratory and autoimmune diagnoses and post-acute symptoms (31-180 days) following SARS-CoV-2 infection were contrasted in treated/untreated groups using competing-risks regressions (adjusted for demographics/vaccination status/comorbidities).

Results: 188,532 older Singaporeans were included; 5.8% (10,905/188,532) received nirmatrelvir/ritonavir. No significantly decreased risk of post-acute 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 post-acute symptom: aHR=0.97[0.80-1.18]) was observed up to 180 days post-infection in nirmatrelvir/ritonavir-treated individuals, versus untreated cases. Across all vaccination and age subgroups, no significantly decreased risk of any post-acute diagnosis/symptom or any cardiovascular, neurological, respiratory and autoimmune complications up to 180 days post-infection was observed.

Conclusion: Early outpatient receipt of nirmatrelvir/ritonavir did not significantly reduce risk of post-acute cardiovascular, neurological, respiratory and autoimmune sequelae or risk of post-acute symptoms in a boosted cohort of older Singaporeans.

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新加坡老年人接受 Nirmatrelvir/ritonavir 治疗与 COVID-19 后遗症的风险。

研究目的：在评估早期口服抗病毒治疗对预防 COVID-19 (PASC) 后急性后遗症的影响的队列研究中，存在明显的异质性。我们评估了早期尼马瑞韦/利托那韦对新加坡老年人急性期后心血管、神经、呼吸和自身免疫诊断风险以及急性期后症状的影响：方法：利用国家 COVID-19 登记和医疗保健索赔数据库构建了一个基于人群的回顾性队列，纳入了所有在 Omicron 传播期间（2022 年 3 月 18 日至 2023 年 8 月 4 日）在初级保健机构确诊感染 SARS-CoV-2 的年龄≥60 岁的新加坡人。人群分为接受过尼马瑞韦/利托那韦治疗组和未接受治疗组。组间基线特征差异采用重叠加权法进行调整。采用竞争风险回归法（根据人口统计学特征/疫苗接种状况/并发症进行调整）对治疗组/未治疗组感染 SARS-CoV-2 后急性心血管、神经、呼吸系统和自身免疫诊断的风险以及急性期后症状（31-180 天）进行对比：共纳入 188,532 名新加坡老年人，其中 5.8%（10,905/188,532）接受了尼马瑞韦/利托那韦治疗。急性期后遗症的风险没有明显降低（任何后遗症：调整后危险比，aHR=1.06[0.94-1.19]；心血管后遗症：aHR=1.01[0.83-1.24]；神经系统后遗症：aHR=1.09[0.95-1.27]；呼吸系统后遗症：aHR=1.与未经治疗的病例相比，接受过尼马瑞韦/利托那韦治疗的病例在感染后 180 天内观察到的后遗症包括：神经系统后遗症：aHR=1.01[0.83-1.24]；呼吸系统后遗症：aHR=1.09[0.95-1.27]；自身免疫后遗症：aHR=1.14[0.84-1.55]；自身免疫后遗症：aHR=0.76[0.53-1.09]或任何急性后症状：aHR=0.97[0.80-1.18]）。在所有疫苗接种和年龄亚组中，均未观察到感染后180天内任何急性诊断/症状或任何心血管、神经、呼吸和自身免疫并发症的风险明显降低：结论：早期门诊接受尼马瑞韦/利托那韦治疗并不能显著降低急性期后心血管、神经系统、呼吸系统和自身免疫后遗症的风险，也不能显著降低新加坡老年人队列中急性期后症状的风险。

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来源期刊

Clinical Microbiology and Infection 医学-传染病学

CiteScore

25.30

自引率

2.10%

发文量

441

审稿时长

2-4 weeks

期刊介绍： Clinical Microbiology and Infection (CMI) is a monthly journal published by the European Society of Clinical Microbiology and Infectious Diseases. It focuses on peer-reviewed papers covering basic and applied research in microbiology, infectious diseases, virology, parasitology, immunology, and epidemiology as they relate to therapy and diagnostics.