Nirmatrelvir-ritonavir for the treatment of COVID-19 patients: A systematic review and meta-analysis.

Nirmatrelvir-ritonavir (Paxlovid™) is an oral antiviral that has been approved for the treatment of mild-to-moderate COVID-19. We aimed to conduct a meta-analysis to evaluate the efficacy and safety of nirmatrelvir-ritonavir in COVID-19 patients. Various databases including PubMed, the Cochrane Library, medRxiv and Embase were searched from inception till 10 October 2022 and results from 12 studies (two randomized controlled trials (RCTs) and 10 observational studies) were pooled using a random-effects model with risk ratio (RR) as the effect measure. Nirmatrelvir-ritonavir reduced the risk of mortality (RR 0.24; 95% CI:0.15-0.37, I =48%; moderate certainty) and hospitalization (RR 0.41; 95% CI:0.29-0.59, I =90%; low certainty) in both patients with or without previous immunity to SARS-CoV-2 without an increased risk of adverse events. Our study provides encouraging evidence for nirmatrelvir-ritonavir as a safe and efficacious agent for COVID-19 but large-scale RCTs are needed to confirm these findings. This article is protected by copyright. All rights reserved.