Effectiveness of nirmatrelvir/ritonavir in children and adolescents aged 12–17 years following SARS-CoV-2 Omicron infection: A target trial emulation

Carlos K. H. Wong (), Kristy T. K. Lau, Ivan C. H. Au, Sophelia H. S. Chan, Eric H. Y. Lau, Benjamin J. Cowling and Gabriel M. Leung
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Carlos K. H. Wong: The University of Hong Kong
Kristy T. K. Lau: The University of Hong Kong
Ivan C. H. Au: The University of Hong Kong
Sophelia H. S. Chan: The University of Hong Kong
Eric H. Y. Lau: Laboratory of Data Discovery for Health (D24H)
Benjamin J. Cowling: Laboratory of Data Discovery for Health (D24H)
Gabriel M. Leung: Laboratory of Data Discovery for Health (D24H)

Nature Communications, 2024, vol. 15, issue 1, 1-7

Abstract: Abstract Currently there is a lack of randomized trial data examining the use of the antiviral nirmatrelvir/ritonavir in paediatric patients with SARS-CoV-2 infection. This target trial emulation study aims to address this gap by evaluating the use of nirmatrelvir/ritonavir in non-hospitalized paediatric patients aged 12–17 years with SARS-CoV-2 Omicron variant infection. Among paediatric patients diagnosed between 16th March 2022 and 5th February 2023, exposure was defined as outpatient nirmatrelvir/ritonavir treatment within 5 days of symptom onset or COVID-19 diagnosis. Primary outcome was 28 day all-cause mortality or all-cause hospitalization, while secondary outcomes were 28 day in-hospital disease progression, 28 day COVID-19-specific hospitalization, multisystem inflammatory syndrome in children (MIS-C), acute liver injury, acute renal failure, and acute respiratory distress syndrome. Overall, 49,378 eligible paediatric patients were included. Nirmatrelvir/ritonavir treatment was associated with reduced 28 day all-cause hospitalization (absolute risk reduction = 0.23%, 95%CI = 0.19%–0.31%; relative risk = 0.66, 95%CI = 0.56–0.71). No events of mortality, in-hospital disease progression, or adverse clinical outcomes were observed among nirmatrelvir/ritonavir users. The findings confirmed the effectiveness of nirmatrelvir/ritonavir in reducing all-cause hospitalization risk among non-hospitalized pediatric patients with SARS-CoV-2 Omicron variant infection.

Date: 2024
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DOI: 10.1038/s41467-024-49235-8

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