Joshua Panyin Craymah, Derek Anamaale Tuoyire, Portia Adjei-Ofori, Oluwayemisi Esther Ekor, Paul Aduoku Ninson, Milton Henschel Kojo Armoh Ewusi
Neonatal sepsis in a tertiary health facility in Cape Coast, Ghana
PloS one
nirmatrelvirritonavir used patients coronavirus disease 2019 covid19 normal mild renal impairment egfr 30 mlmin per 173 m2 limited data regarding use advanced kidney disease egfr 30 mlmin per 173 m2 performed retrospective territorywide observational study evaluating safety efficacy nirmatrelvirritonavir compared molnupiravir treatment patients covid19 advanced kidney disease adopted target trial emulation using data territorywide electronic health record database eligible patients aged 18 years advanced kidney disease history egfr 30 mlmin per 173 m2 infected covid19 prescribed either molnupiravir nirmatrelvirritonavir within five days infection period 16 march 2022 31 december 2022 sequence trial approach 14 propensity score matching applied based baseline covariates including age sex number covid19 vaccine doses received charlson comorbidity index cci hospitalisation egfr renal replacement therapy comorbidities cancer respiratory disease myocardial infarction ischaemic stroke diabetes hypertension drug use reninangiotensinsystem agents beta blockers calcium channel blockers diuretics nitrates lipid lowering agents insulins oral antidiabetic drugs antiplatelets immunosuppressants corticosteroids proton pump inhibitors histamine h2 receptor antagonists monoclonal antibody infusion within past 90 days individuals followed index date earliest outcome occurrence death 90 days index date end data availability stratified cox proportional hazards regression adjusted baseline covariates used compare risk outcomes nirmatrelvirritonavir recipients molnupiravir recipients include allcause mortality ii intensive care unit icu admission iii ventilatory support iv hospitalisation v hepatic impairment vi ischaemic stroke vii myocardial infarction subgroup analyses included age 70 70 years sex charlson comorbidity index 5 5 number covid19 vaccine doses received 01 2 doses total 4886 patients included nirmatrelvirritonavir 1462 molnupiravir 3424 347 events allcause mortality nirmatrelvirritonavir 74 506 molnupiravir 273 797 10 events icu admission nirmatrelvirritonavir 4 027 molnupiravir 6 018 48 events ventilatory support nirmatrelvirritonavir 13 089 molnupiravir 35 102 836 events hospitalisation nirmatrelvirritonavir 218 2398 molnupiravir 618 2814 1 event hepatic impairment nirmatrelvirritonavir 0 0 molnupiravir 1 003 8 events ischaemic stroke nirmatrelvirritonavir 3 022 molnupiravir 5 016 9 events myocardial infarction nirmatrelvirritonavir 2 015 molnupiravir 7 022 nirmatrelvirritonavir users lower rates allcause mortality absolute risk reduction arr 90 days 291 95 ci 147436 hospitalisation arr 90 days 416 95 ci 081751 compared molnupiravir users similar rates icu admission arr 90 days 009 95 ci 04 02 ventilatory support arr 90 days 013 95 ci 045 072 hepatic impairment arr 90 days 003 95 ci 003 009 ischaemic stroke arr 90 days 006 95 ci 035 022 myocardial infarction arr 90 days 007 95 ci 019 033 found nirmatrelvirritonavir molnupiravir users consistent results observed relative risk adjusted baseline characteristics nirmatrelvirritonavir associated significantly reduced risk allcause mortality hr 0624 95 ci 04550857 hospitalisation hr 0782 95 ci 0640954 patients covid19 advanced kidney disease receiving nirmatrelvirritonavir lower rate allcause mortality hospital admission compared molnupiravir adverse clinical outcomes similar treatment groups health medical research fund covid1903010 health bureau government hong kong special administrative region china