{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:05:27Z","timestamp":1788433527231,"version":"build-2803163510"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2022,8,20]],"date-time":"2022-08-20T00:00:00Z","timestamp":1660953600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,2,18]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Treatment of coronavirus disease 2019 (COVID-19) with nirmatrelvir plus ritonavir (NMV-r) in high-risk nonhospitalized unvaccinated patients reduced the risk of progression to severe disease. However, the potential benefits of NMV-r among vaccinated patients are unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a comparative retrospective cohort study using the TriNetX research network. Patients \u226518 years of age who were vaccinated and subsequently developed COVID-19 between 1 December 2021 and 18 April 2022 were included. Cohorts were developed based on the use of NMV-r within 5 days of diagnosis. The primary composite outcome was all-cause emergency room (ER) visit, hospitalization, or death at a 30-day follow-up. Secondary outcomes included individual components of primary outcomes, multisystem symptoms, COVID-19\u2013associated complications, and diagnostic test utilization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After propensity score matching, 1130 patients remained in each cohort. A primary composite outcome of all-cause ER visits, hospitalization, or death in 30 days occurred in 89 (7.87%) patients in the NMV-r cohort compared with 163 (14.4%) patients in the non\u2013NMV-r cohort (odds ratio: .5; 95% confidence interval: .39\u2013.67; P &amp;lt; .005) consistent with 45% relative risk reduction. A significant reduction in multisystem symptom burden and subsequent complications, such as lower respiratory tract infection, cardiac arrhythmia, and diagnostic radiology testing, were noted in NMV-r\u2013treated patients. There was no apparent increase in serious complications between days 10 and 30.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Treatment with NMV-r in nonhospitalized vaccinated patients with COVID-19 was associated with a reduced likelihood of ER visits, hospitalization, or death. Complications and overall resource utilization were also decreased.<\/jats:p><\/jats:sec>","DOI":"10.1093\/cid\/ciac673","type":"journal-article","created":{"date-parts":[[2022,8,20]],"date-time":"2022-08-20T08:57:39Z","timestamp":1660985859000},"page":"563-572","source":"Crossref","is-referenced-by-count":126,"title":["Oral Nirmatrelvir and Ritonavir in Nonhospitalized Vaccinated Patients With Coronavirus Disease 2019"],"prefix":"10.1093","volume":"76","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0296-6864","authenticated-orcid":false,"given":"Sarju","family":"Ganatra","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health , Burlington, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sourbha S","family":"Dani","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health , Burlington, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javaria","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health , Burlington, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashish","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cleveland Clinic Akron General , Akron, Ohio , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jui","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health , Burlington, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George M","family":"Abraham","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Department of Medicine, Saint Vincent Hospital , Worcester, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel P","family":"McQuillen","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health , Burlington, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M","family":"Wachter","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California San Francisco , San Francisco, California , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul E","family":"Sax","sequence":"additional","affiliation":[{"name":"Division of Infectious Disease, Department of Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School , Boston, Massachusetts , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,8,20]]},"reference":[{"key":"2023021818291658800_","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1056\/NEJMoa2118542","article-title":"Oral nirmatrelvir for high-risk, nonhospitalized adults with Covid-19","volume":"386","author":"Hammond","year":"2022","journal-title":"N Engl J Med"},{"key":"2023021818291658800_","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1056\/NEJMoa2116044","article-title":"Molnupiravir for oral treatment of Covid-19 in nonhospitalized patients","volume":"386","author":"Jayk Bernal","year":"2022","journal-title":"N Engl J Med"},{"key":"2023021818291658800_","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1056\/NEJMoa2116846","article-title":"Early remdesivir to prevent progression to severe Covid-19 in outpatients","volume":"386","author":"Gottlieb","year":"2022","journal-title":"N Engl J 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