Paxlovid use is associated with lower risk of cardiovascular diseases in COVID-19 patients with autoimmune rheumatic diseases: a retrospective cohort study.

Publisher: BioMed Central Country of Publication: England NLM ID: 101190723 Publication Model: Electronic Cited Medium: Internet ISSN: 1741-7015 (Electronic) Linking ISSN: 17417015 NLM ISO Abbreviation: BMC Med Subsets: MEDLINE

Original Publication: [London] : BioMed Central, 2003-

COVID-19*/complications ; COVID-19*/epidemiology ; Cardiovascular Diseases*/epidemiology ; Cardiovascular Diseases*/complications ; Autoimmune Diseases*/complications ; Autoimmune Diseases*/drug therapy ; Autoimmune Diseases*/epidemiology ; Rheumatic Diseases*/complications ; Rheumatic Diseases*/drug therapy ; Rheumatic Diseases*/epidemiology ; Ritonavir* ; Nitriles* ; Leucine* ; Proline* ; Lactams*; Humans ; Male ; Infant, Newborn ; Retrospective Studies ; COVID-19 Testing ; Risk Factors ; Drug Combinations

Background: Paxlovid has been shown to be effective in reducing mortality and hospitalization rates in patients with coronavirus disease 2019 (COVID-19). It is not known whether Paxlovid can reduce the risk of cardiovascular diseases (CVD) in COVID-19-surviving patients with autoimmune rheumatic diseases (AIRDs).
Methods: TriNetX data from the US Collaborative Network were used in this study. A total of 5,671,395 patients with AIRDs were enrolled between January 1, 2010, and December 31, 2021. People diagnosed with COVID-19 were included in the cohort (n = 238,142) from January 1, 2022, to December 31, 2022. The Study population was divided into two groups based on Paxlovid use. Propensity score matching was used to generate groups with matched baseline characteristics. The hazard ratios (HRs) and 95% confidence intervals of cardiovascular outcomes, admission rate, mortality rate, and intensive care unit (ICU) admission rate were calculated between Paxlovid and non-Paxlovid groups. Subgroup analyses on sex, age, race, autoimmune diseases group, and sensitivity analyses for Paxlovid use within the first day or within 2-5 days of COVID-19 diagnosis were performed.
Results: Paxlovid use was associated with lower risks of cerebrovascular complications (HR = 0.65 [0.47-0.88]), arrhythmia outcomes (HR = 0.81 [0.68-0.94]), ischemic heart disease, other cardiac disorders (HR = 0.51 [0.35-0.74]) naming heart failure (HR = 0.41 [0.26-0.63]) and deep vein thrombosis (HR = 0.46 [0.24-0.87]) belonging to thrombotic disorders in AIRD patients with COVID-19. Compared with the Non-Paxlovid group, risks of major adverse cardiac events (HR = 0.56 [0.44-0.70]) and any cardiovascular outcome mentioned above (HR = 0.76 [0.66-0.86]) were lower in the Paxlovid group. Moreover, the mortality (HR = 0.21 [0.11-0.40]), admission (HR = 0.68 [0.60-0.76]), and ICU admission rates (HR = 0.52 [0.33-0.80]) were significantly lower in the Paxlovid group than in the non-Paxlovid group. Paxlovid appears to be more effective in male, older, and Black patients with AIRD. The risks of cardiovascular outcomes and severe conditions were reduced significantly with Paxlovid prescribed within the first day of COVID-19 diagnosis.
Conclusions: Paxlovid use is associated with a lower risk of CVDs and severe conditions in COVID-19-surviving patients with AIRD.
(© 2024. The Author(s).)

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82004238 National Natural Science Foundation of China

Keywords: Autoimmune rheumatic diseases; COVID-19; Cardiovascular outcomes; Paxlovid; TriNetX

0 (nirmatrelvir and ritonavir drug combination)
O3J8G9O825 (Ritonavir)
0 (Nitriles)
0 (Drug Combinations)
GMW67QNF9C (Leucine)
9DLQ4CIU6V (Proline)
0 (Lactams)

Date Created: 20240314 Date Completed: 20240315 Latest Revision: 20240316

20240316

PMC10938827

10.1186/s12916-024-03331-0

38481216