奈玛特韦/利托那韦治疗后新型冠状病毒感染反弹的系统评价  

Systematic evaluation of COVID-19 rebound after Nirmatrelvir/Ritonavir treatment:a Meta-analysis

作　　者：王东晓 任昭[1] 刘桦[1] 李春杏 WANG Dongxiao;REN Zhao;LIU Hua;LI Chunxing(Department of Pharmacy,Aerospace Center Hospital,Beijing 100049,China)

机构地区：[1]航天中心医院药剂科,北京100049

出　　处：《中国医院药学杂志》2024年第21期2492-2497,2511,共7页Chinese Journal of Hospital Pharmacy

摘　　要：目的:系统评价奈玛特韦/利托那韦(Nirmatrelvir/Ritonavir,NMV/r)治疗后新型冠状病毒感染(coronavirus disease2019,COVID-19)患者的病毒和/或症状反弹风险。方法:检索PubMed、Embase、Cochrane Library、Clinical Trials、万方数据库和中国知网自2018年1月1日至2023年11月2日NMV/r治疗后出现COVID-19反弹的相关文献,纳入使用NMV/r(观察组)和莫诺拉韦或未抗病毒治疗(对照组)的相关临床研究,提取资料并评价质量。采用STATA 12.0统计软件进行Meta分析。结果:共纳入12项队列研究和1项随机对照研究。抗病毒治疗后,NMV/r组的病毒反弹率、症状反弹率、病毒和/或症状反弹率分别为4.72%、3.75%、7.24%,Meta分析结果显示,与对照组相比差异均无统计学意义[病毒反弹:OR=1.46,95%CI(0.91,2.33),P=0.116;症状反弹:OR=0.85,95%CI(0.58,1.25),P=0.093;病毒和/或症状反弹:OR=0.76,95%CI(0.37,1.55),P=0.452]。亚组分析结果显示,NMV/r组的症状反弹率显著低于莫诺拉韦组[OR=0.67,95%CI(0.48,0.92),P=0.015],与未抗病毒治疗组相当[OR=1.43,95%CI(0.45,4.57),P=0.684]。结论:COVID-19反弹可见于NMV/r、莫诺拉韦和未抗病毒治疗患者中。NMV/r与未抗病毒治疗的COVID-19反弹风险相当。与莫诺拉韦相比,NMV/r的症状反弹率较低,病毒反弹风险相似。由于纳入研究的局限性,该结论有待更多的大样本临床试验进一步验证。OBJECTIVE To systematically evaluate the risk of virus and/or symptom rebound after Nirmatrelvir/Ritonavir(NMV/r)treatment in patients with coronavirus disease 2019(COVID-19).METHODS From January 1,2018 to November 2,2023,the databases of PubMed,Embase,Cochrane Library,Clinical Trials,Wanfang and China National Knowledge Infrastructure(CNKI)were searched for the related literature of COVID-19 rebound in patients treated with NMV/r(observation group)and molnupiravir or no antiviral drugs(control group).After information collection and quality evaluation,meta-analysis was performed by STATA 12.0 software.RESULTS A total of 12 cohort studies and 1 randomized controlled trial were included.Rate of viral rebound,symptom rebound,viral and/or symptom rebound after NMV/r treatment were 4.72%,3.75%and 7.24%,respectively.Meta-analysis results revealed no significant differences in viral rebound[OR=1.46,95%CI(0.91,2.33),P=0.116],symptom rebound[OR=0.85,95%CI(0.58,1.25),P=0.093]and virus and/or symptom rebound[OR=0.76,95%CI(0.37,1.55),P=0.452]between NMV/r and control groups.Subgroup analysis indicated that symptom rebound rate was significantly lower in NMV/r group than that in molnupiravir group[OR=0.67,95%CI(0.48,0.92),P=0.015].It was comparable to that in group without antiviral drugs[OR=1.43,95%CI(0.45,4.57),P=0.684].CONCLUSION COVID-19 rebound may appear in patients treated with NMV/r,molnupiravir and no antiviral drugs.The risk of COVID-19rebound does not differ between NMV/r group and group without antiviral drugs.Symptom rebound rate of NMV/r is lower than that of molnupiravir and viral rebound rate is similar between them.However,due to the limitations of the included studies,these results should be further verified by more large-sample clinical trials.

关 键 词：奈玛特韦/利托那韦 COVID-19 病毒反弹 症状反弹 META分析 

分 类 号：R969.4[医药卫生—药理学]