Effectiveness and safety of nirmatrelvir+ritonavir in COVID-19. NiRCoV Study: Correspondence

Dear Editor,

We would like to comment on “Effectiveness and safety of nirmatrelvir + ritonavir in COVID-19. NiRCoV Study.¹” In this study, persons with mild to moderate COVID-19 who are at high risk of developing severe disease were asked to evaluate the effectiveness and possible safety issues of using nirmatrelvir + ritonavir (NMV-r) (Paxlovid®). One hundred thirty-four patients who received treatment between June and September of 2022 were enrolled in the study, which employed a descriptive cross-sectional observational study design. Important demographic and related data are provided by the results.

Statistically, although the results provide interesting information on risk factors associated with disease progression, such as age over 65 and immunocompromised status, treatment outcomes were reported to be 2.2% hospitalization and 3.0% death, which are considered low rates. However, because the sample size was insufficient and the comparison to an untreated control group was incomplete, it may not accurately reflect the treatment's efficacy.

One of the study's primary weaknesses is a lack of control over factors that could have influenced treatment outcomes, such as the usage of concomitant drugs that may interact with NMV-r, which was reported by 62.9% of patients. This may influence the outcomes of drug efficacy and safety assessments based on these criteria. This study raises an important question about whether using NMV-r in high-risk individuals can slow the progression to severe illness. This study may pave the way for future research to evaluate the efficacy of this treatment to other treatment modalities, as well as studies with larger sample sizes to produce more credible results. Furthermore, extensive research into the management of drug interactions should be done to avoid any safety hazards during treatment.

CRediT authorship contribution statement

HD: 50% ideas, writing, analyzing, approval.

VW: 50% ideas, supervision, approval.

Ethical approval

Not applicable.

Funding

There is no funding.

Declaration of generative AI and AI-assisted technologies in the writing process

The authors used computational tool for language editing/checking in preparation of the article.

Conflict of interest

Authors declare no conflict of interest.