Characteristics and clinical outcomes of nirmatrelvir/ritonavir (PaxlovidTM) recipients in Canada, 2022: a descriptive cohort study

TL;DR

This study describes the real-world use and outcomes of Paxlovid in Canada during 2022, showing it was mainly given to older, vaccinated individuals with comorbidities and had rare severe outcomes.

Contribution

The study provides real-world evidence on Paxlovid usage and outcomes in a large Canadian cohort during the Omicron wave.

Findings

Most recipients were 60+ years old, vaccinated, and had comorbidities.

Severe outcomes like death or hospitalization were rare, with risk factors including immunosuppression and being unvaccinated.

N/R was associated with uncommon severe 30-day outcomes in high-risk populations.

Abstract

Nirmatrelvir/ritonavir (N/R) (PaxlovidTM) was introduced in Canada in January 2022. This was the first oral coronavirus disease 2019 (COVID-19) antiviral therapy that was deployed on a large scale in Canada. Since N/R was a new therapeutic option to reduce severe outcomes in high-risk populations, clinical and implementation questions were raised about its real-world utilization and impact. The objective of this retrospective observational study was to describe the characteristics and clinical outcomes of recipients of N/R in the first several months of its availability in Canada, during the Omicron wave.

Provincial summary data were pooled together for the analysis. Descriptive statistics were used to explore the characteristics and clinical outcomes of the recipients. Pearson’s Chi-square test and unadjusted odds ratio along with 95% confidence intervals were used to identify the potential risk factors for severe outcomes. Data were generally collected between January and September 2022.

Seventy-six percent of N/R recipients were 60 years of age and older and 56% were female. Eighty-four percent of recipients had received three or more COVID-19 vaccinations and 67% had comorbidities. All-cause severe 30-day outcomes were uncommon, with 0.4% reported as deceased, 0.1% admitted to the intensive care unit and 2.0% hospitalized after N/R administration. Risk factors statistically associated with severe outcomes were immunosuppression, comorbidities, age of 60 years and older, and being unvaccinated.

In the first months of its availability in Canada, N/R was mostly used in vaccinated patients 60 years and older with one or more comorbidities. Severe outcomes in N/R recipients were uncommon and mostly reported in patients with risk factors.

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