{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T16:15:11Z","timestamp":1761754511157,"version":"build-2065373602"},"reference-count":40,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Institut National d\u2019Excellence en Sant\u00e9 et en Services Sociaux"},{"name":"INESSS"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The nirmatrelvir-ritonavir has shown to reduce coronavirus disease 2019 (COVID-19) hospitalization and death before the Omicron era, but updated real-world evidence studies are needed. The current study aimed to assess whether nirmatrelvir-ritonavir reduces the risk of COVID-19\u2013associated hospitalization among high-risk outpatients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective cohort study of severe acute respiratory syndrome coronavirus 2\u2013infected outpatients between 15 March and 15 October 2022, using data from the Qu\u00e9bec clinico-administrative databases. Propensity score matching was used to compare infected outpatients treated with nirmatrelvir-ritonavir with those not receiving nirmatrelvir-ritonavir. The relative risk (RR) of COVID-19\u2013associated hospitalization occurring within 30 days following the index date was assessed using a Poisson regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 14 756 treated outpatients were matched to controls. Regardless of vaccination status, nirmatrelvir-ritonavir treatment was associated with a 74% reduced RR of hospitalization (RR, 0.26 [95% confidence interval [CI], .23\u2013.29]; number needed to treat [NNT, 15). The effect was more pronounced in outpatients with an incomplete primary vaccination course (RR, 0.13 [95% CI, .08\u2013.20]; NNT, 9). Benefit was also found in those with a complete primary vaccination course (RR, 0.28 [95% CI, .25\u2013.32]; NNT, 17) regardless of age and the delay since the last vaccination. Subgroups analysis among high-risk outpatients with a primary vaccination course showed that nirmatrelvir-ritonavir treatment was associated with a significant decrease in the RR of hospitalization in severely immunocompromised outpatients (RR, 0.28 [95% CI, .21\u2013.36]; NNT, 7), regardless of the delay since the last vaccination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nirmatrelvir-ritonavir reduces the risk of COVID-19\u2013associated hospitalization among incompletely and completely vaccinated high-risk outpatients, as well as immunocompromised individuals, regardless of age and the delay since the last vaccination.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/cid\/ciaf145","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T16:11:39Z","timestamp":1761754299000},"source":"Crossref","is-referenced-by-count":0,"title":["Real-World Effectiveness of Nirmatrelvir-Ritonavir in Preventing Coronavirus Disease 2019\u2013Associated Hospitalization: A Population-Based Cohort Study in the Province of Qu\u00e9bec, Canada"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7205-206X","authenticated-orcid":false,"given":"Jean-Luc","family":"Kabor\u00e9","sequence":"first","affiliation":[{"name":"Institut National d'Excellence en Sant\u00e9 et en Services Sociaux (INESSS) du Qu\u00e9bec (Qu\u00e9bec National Institute for Excellence in Health and Social Services), Montr\u00e9al , Qu\u00e9bec ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beno\u00eet","family":"Laffont","sequence":"additional","affiliation":[{"name":"Institut National d'Excellence en Sant\u00e9 et en Services Sociaux (INESSS) du Qu\u00e9bec (Qu\u00e9bec National Institute for Excellence in Health and Social Services), Montr\u00e9al , Qu\u00e9bec ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mamadou","family":"Diop","sequence":"additional","affiliation":[{"name":"Institut National d'Excellence en Sant\u00e9 et en Services Sociaux (INESSS) du Qu\u00e9bec (Qu\u00e9bec National Institute for Excellence in Health and Social Services), Montr\u00e9al , Qu\u00e9bec ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melanie R","family":"Tardif","sequence":"additional","affiliation":[{"name":"Institut National d'Excellence en Sant\u00e9 et en Services Sociaux (INESSS) du Qu\u00e9bec (Qu\u00e9bec National Institute for Excellence in Health and Social Services), Montr\u00e9al , Qu\u00e9bec ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexis F","family":"Turgeon","sequence":"additional","affiliation":[{"name":"CHU de Qu\u00e9bec\u2013Universit\u00e9 Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine) , Qu\u00e9bec City, Qu\u00e9bec ,","place":["Canada"]},{"name":"Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Universit\u00e9 Laval , Qu\u00e9bec City, Qu\u00e9bec ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeannot","family":"Dumaresq","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Microbiology-Infectiology and Immunology, Universit\u00e9 Laval , Qu\u00e9bec City, Qu\u00e9bec ,","place":["Canada"]},{"name":"Department of Microbiology and Infectious Diseases, Centre Int\u00e9gr\u00e9 de Sant\u00e9 et de Services Sociaux de Chaudi\u00e8re-Appalaches , L\u00e9vis, Qu\u00e9bec ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Me-Linh","family":"Luong","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, Centre Hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al (CHUM) , Montr\u00e9al, Qu\u00e9bec ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michel","family":"Cauchon","sequence":"additional","affiliation":[{"name":"Department of Family Practice and Emergency, Universit\u00e9 Laval , Qu\u00e9bec City, Qu\u00e9bec ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugo","family":"Chapdelaine","sequence":"additional","affiliation":[{"name":"Institut de Recherches Cliniques de Montr\u00e9al, University of Montr\u00e9al , Montr\u00e9al, Qu\u00e9bec ,","place":["Canada"]},{"name":"Department of Medicine, Centre Hospitalier de l'Universit\u00e9 de Montr\u00e9al (CHUM), Centre de Recherches du CHUM, Montr\u00e9al , Qu\u00e9bec ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Claveau","sequence":"additional","affiliation":[{"name":"Departments of Emergency Medicine and Critical Care Medicine, Centre Int\u00e9gr\u00e9 Universitaire de Sant\u00e9 et de Services Sociaux de la Mauricie-et-du-Centre-du-Qu\u00e9bec, Centre Hospitalier Affili\u00e9 Universitaire R\u00e9gional , Trois-Rivi\u00e8res, Qu\u00e9bec ,","place":["Canada"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Brosseau","sequence":"additional","affiliation":[{"name":"Department of Medicine, Pulmonary and Critical Care Medicine Divisions, H\u00f4pital Maisonneuve-Rosemont, CIUSSS de l'Est-de-l'\u00cele-de-Montr\u00e9al , Montr\u00e9al, Qu\u00e9bec ,","place":["Canada"]},{"name":"Department of Medicine, Faculty of Medicine, Universit\u00e9 de Montr\u00e9al , Montr\u00e9al, Qu\u00e9bec 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An empirical study of summary effect measures in meta-analyses","volume":"31","author":"Furukawa","year":"2002","journal-title":"Int J Epidemiol"},{"key":"2025102912113332000_ciaf145-B9","doi-asserted-by":"crossref","first-page":"e28497","DOI":"10.1002\/jmv.28497","article-title":"Nirmatrelvir-ritonavir therapy and COVID-19 vaccination improve clinical outcomes of SARS-CoV-2 Omicron variant infection","volume":"95","author":"Qi","year":"2023","journal-title":"J Med Virol"},{"key":"2025102912113332000_ciaf145-B10","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1093\/cid\/ciac673","article-title":"Oral nirmatrelvir and ritonavir in nonhospitalized vaccinated patients with coronavirus disease 2019","volume":"76","author":"Ganatra","year":"2023","journal-title":"Clin Infect 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