Health science reports · 2026
Effectiveness and Safety of Nirmatrelvir/Ritonavir (Paxlovid) Versus Remdesivir in COVID-19: A Systematic Review and Meta-Analysis of Retrospective Studies.
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Akbarzadeh Arash, Razeghian Masoud, Hajiabadi Foruzan, Dehghan Parvaneh, Ahmadi-Mazhin Sadegh, Eshaghzadeh Maliheh, Poursadeqiyan Mohsen, Shabestan Rouhollah
Аннотация
BACKGROUND AND AIM: Nirmatrelvir/ritonavir (Paxlovid) and remdesivir are antiviral agents that have been widely used in the management of patients with Coronavirus disease 2019 (COVID-19). This systematic review and meta-analysis were conducted to compare the clinical effectiveness and safety outcomes of Paxlovid and remdesivir among patients with COVID-19.
METHODS: A systematic search was performed across the Cochrane Library, Web of Science, PubMed, and medRxiv from inception to July 2024. Data from the identified studies were analyzed using Comprehensive Meta-Analysis (CMA) software.
RESULTS: Thirteen studies involving 4583 patients were included in the final analysis. Compared with remdesivir, Paxlovid was associated with a significant reduction in mortality (odds ratio [OR] = 0.36, 95% confidence interval [CI]: 0.18-0.73), time to SARS-CoV-2 negative conversion (standardized mean differences [SMD] = -1.44, 95% CI: -1.54 to -1.33), hospitalization (OR = 0.34, 95% CI: 0.16-0.74), intensive care unit admission (OR = 0.10, 95% CI: 0.01-0.53), and the need for oxygen therapy (OR = 0.06, 95% CI: 0.02-0.16). No statistically significant difference was observed between the two treatments regarding polymerase chain reaction negativity rate (OR = 1.45, 95% CI: 0.73-2.86). However, adverse events were higher among patients receiving Paxlovid (OR = 6.60, 95% CI: 3.24-13.42). The certainty of evidence for the evaluated outcomes ranged from low to moderate.
CONCLUSION: In patients with COVID-19, Paxlovid may offer potential benefits over remdesivir for certain clinical outcomes, though it may also be accompanied by a higher rate of adverse events. These findings are based on retrospective studies, which carry risks of selection bias, confounding, and heterogeneity.
METHODS: A systematic search was performed across the Cochrane Library, Web of Science, PubMed, and medRxiv from inception to July 2024. Data from the identified studies were analyzed using Comprehensive Meta-Analysis (CMA) software.
RESULTS: Thirteen studies involving 4583 patients were included in the final analysis. Compared with remdesivir, Paxlovid was associated with a significant reduction in mortality (odds ratio [OR] = 0.36, 95% confidence interval [CI]: 0.18-0.73), time to SARS-CoV-2 negative conversion (standardized mean differences [SMD] = -1.44, 95% CI: -1.54 to -1.33), hospitalization (OR = 0.34, 95% CI: 0.16-0.74), intensive care unit admission (OR = 0.10, 95% CI: 0.01-0.53), and the need for oxygen therapy (OR = 0.06, 95% CI: 0.02-0.16). No statistically significant difference was observed between the two treatments regarding polymerase chain reaction negativity rate (OR = 1.45, 95% CI: 0.73-2.86). However, adverse events were higher among patients receiving Paxlovid (OR = 6.60, 95% CI: 3.24-13.42). The certainty of evidence for the evaluated outcomes ranged from low to moderate.
CONCLUSION: In patients with COVID-19, Paxlovid may offer potential benefits over remdesivir for certain clinical outcomes, though it may also be accompanied by a higher rate of adverse events. These findings are based on retrospective studies, which carry risks of selection bias, confounding, and heterogeneity.