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<p>Nirmatrelvir-ritonavir is generally recommended to be initiated within five days of COVID-19 symptom onset. This study examined the association between the timing of nirmatrelvir-ritonavir initiation and post-acute outcomes more precisely using territory-wide data in Hong Kong. We included patients aged ≥18 years who tested positive for SARS-CoV-2 between March 16, 2022, and November 9, 2023, and were hospitalized with COVID-19. Treatment groups were formed based on the time from the positive RT-PCR date to nirmatrelvir-ritonavir initiation. Among 15,978 patients who received nirmatrelvir-ritonavir, 10,028 (62.8%) patients were included in Day 0 group, 4973 (31.1%) in Day 1 group, and 977 (6.1%) in Day 2 or later group. The control group comprised 22,312 patients who did not receive nirmatrelvir-ritonavir. Compared with the control group, the risks of post-acute mortality were significantly lower in Day 0 group (hazard ratio [HR] 0.51, 95% CI 0.46–0.56; <i>p</i> &lt; 0.0001) and Day 1 group (HR 0.66, CI 0.59–0.74; <i>p</i> &lt; 0.0001), but not in Day 2 or later group. Meta-regression results showed that more immediate initiation was associated with lower risks of death and all-cause hospitalization. Our findings suggested that the antiviral should be prescribed immediately after COVID-19 diagnosis for achieving its greatest benefit on improving post-COVID outcomes.</p>

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Greater benefits of immediate nirmatrelvir-ritonavir initiation for post-COVID outcomes: a population-based retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月10日

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  • Ka Chun Chong,
  • Yuchen Wei,
  • Carlos King Ho Wong,
  • Xi Xiong,
  • Huwen Wang,
  • Chi Tim Hung,
  • Conglu Li,
  • Carrie Ho Kwan Yam,
  • Tsz Yu Chow,
  • Zihao Guo,
  • Kehang Li,
  • Aimin Yang,
  • Chris Ka Pun Mok,
  • David S. C. Hui,
  • Shi Zhao,
  • Eng Kiong Yeoh,
  • Guozhang Lin

摘要

Nirmatrelvir-ritonavir is generally recommended to be initiated within five days of COVID-19 symptom onset. This study examined the association between the timing of nirmatrelvir-ritonavir initiation and post-acute outcomes more precisely using territory-wide data in Hong Kong. We included patients aged ≥18 years who tested positive for SARS-CoV-2 between March 16, 2022, and November 9, 2023, and were hospitalized with COVID-19. Treatment groups were formed based on the time from the positive RT-PCR date to nirmatrelvir-ritonavir initiation. Among 15,978 patients who received nirmatrelvir-ritonavir, 10,028 (62.8%) patients were included in Day 0 group, 4973 (31.1%) in Day 1 group, and 977 (6.1%) in Day 2 or later group. The control group comprised 22,312 patients who did not receive nirmatrelvir-ritonavir. Compared with the control group, the risks of post-acute mortality were significantly lower in Day 0 group (hazard ratio [HR] 0.51, 95% CI 0.46–0.56; p < 0.0001) and Day 1 group (HR 0.66, CI 0.59–0.74; p < 0.0001), but not in Day 2 or later group. Meta-regression results showed that more immediate initiation was associated with lower risks of death and all-cause hospitalization. Our findings suggested that the antiviral should be prescribed immediately after COVID-19 diagnosis for achieving its greatest benefit on improving post-COVID outcomes.