Association of nirmatrelvir–ritonavir with post-acute sequelae and mortality among patients who are immunocompromised with COVID-19 in Hong Kong: a retrospective cohort study
Main finding · Post-acute inpatient death, immunocompromised patientsResult — go to the resultHazard ratio 0.58 95% CI 0.45–0.74Authors' conclusion
Nirmatrelvir-ritonavir was associated with reduced risk of post-acute inpatient death among patients who were immunocompromised and admitted to hospital with COVID-19. However, the effectiveness of nirmatrelvir-ritonavir on post-acute hospitalisation outcomes was less pronounced in patients who were immunocompromised than in patients who were immunocompetent.
Study context
- Population
- Adults aged 18 years or older admitted to hospital with COVID-19 (positive SARS-CoV-2 test), Hong Kong, March 11, 2022, to Nov 9, 2023; median age 75.0 years2,217 immunocompromised
- Participants
- 39,923 adults
- Exposure
- Nirmatrelvir-ritonavir vs no nirmatrelvir-ritonavir, in immunocompromised and immunocompetent patients
- Immunocompromised, nirmatrelvir-ritonavirn = 846
- Immunocompetent, nirmatrelvir-ritonavirn = 14,586
- Outcome
- Post-acute inpatient death, starting from 21 days after the positive RT-PCR date
Methodological detailsterritory-wide electronic health records, standardised mortality ratio weighting with doubly robust adjustment, Cox models
- Territory-wide electronic health records
- Standardised mortality ratio weighting with doubly robust adjustment
- Cox models
Main finding
As reported in the abstract
Post-acute inpatient death, immunocompromised patients
Hazard ratio
0.58
95% CI 0.45–0.74
P < 0.0001
Immunocompromised, nirmatrelvir-ritonavirvs Immunocompromised, no nirmatrelvir-ritonavir
HR 0.58 (95% CI 0.45–0.74); P < 0.0001
Observational data: associations, not effects.
Further findings
| Outcome | HR (CI) | P value | |
|---|---|---|---|
| Hospitalisation for acute respiratory distress syndrome, immunocompromised patientsImmunocompromised, nirmatrelvir-ritonavirvs Immunocompromised, no nirmatrelvir-ritonavir | 0.43 (0.20–0.90) | P = 0.024 | |
| 0.20.5125Hazard ratio (log scale) |
Post-acute all-cause hospitalisation: interaction between immune status and nirmatrelvir-ritonavir
- Relative excess risk due to interaction
- −0.84 (95% CI −1.30 to −0.37; p=0.0004)
- Significant negative interaction
Original publication
Association of nirmatrelvir–ritonavir with post-acute sequelae and mortality among patients who are immunocompromised with COVID-19 in Hong Kong: a retrospective cohort study. Lancet Rheumatol. Published 8 November 2024. doi:10.
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