BC 046 – Efficacité du nirmatrelvir oral dans le traitement ambulatoire de la COVID-19 (étude EPIC-HR)

BaladoCritique - club de lecture médical

Dans cette 46e baladodiffusion, le Dr Luc Lanthier discute de l’efficacité du nirmatrelvir/ritonavir (Paxlovid), un nouvel agent antiviral, comme traitement des sujets ambulatoires avec COVID-19, en plus de réviser la littérature médicale de janvier 2022.

Quiz clinique (4 min 32), étude principale (5 min 00), critique (24 min 59), autres articles (38 min 35), réponse au quiz clinique (48 min 57)

Référence principale

Hammond J, Leister-Tebbe H, Gardner A, et al. Oral nirmatrelvir for high-risk, nonhospitalized adults with Covid-19. N Engl J Med. DOI: 10.1056/NEJMoa2118542. PubMed PMID: 35172054.

Articles associés

Rubin EJ, Baden LR. The Potential of Intentional Drug Development. N Engl J Med. DOI: 10.1056/NEJMe2202160. PubMed PMID: 35172055.

Takashita E, Kinoshita N, Yamayoshi S, et al. Efficacy of Antibodies and Antiviral Drugs against Covid-19 Omicron Variant. N Engl J Med. DOI: 10.1056/NEJMc2119407. PubMed PMID: 35081300.

Owen DR, Allerton CMN, Anderson AS, Aschenbrenner L, Avery M, Berritt S, et al. An oral SARS-CoV-2 M^pro inhibitor clinical candidate for the treatment of COVID-19. Science. 2021;374(6575):1586-1593. PubMed PMID: 34726479.

Simonis A, Theobald SJ, Fatkenheuer G, Rybniker J, Malin JJ. A comparative analysis of remdesivir and other repurposed antivirals against SARS-CoV-2. EMBO Mol Med. 2021;13(1):e13105. PubMed PMID: 33015938.

Heskin J, Pallett SJC, Mughal N, Davies GW, Moore LSP, Rayment M, et al. Caution required with use of ritonavir-boosted PF-07321332 in COVID-19 management. Lancet. 2022;399(10319):21-2. PubMed PMID: 34973713.

Collie S, Champion J, Moultrie H, Bekker LG, Gray G. Effectiveness of BNT162b2 Vaccine against Omicron Variant in South Africa. N Engl J Med. 2022;386(5):494-496. PubMed PMID: 34965358.

Johnson AG, Amin AB, Ali AR, Hoots B, Cadwell BL, Arora S, et al. COVID-19 Incidence and Death Rates Among Unvaccinated and Fully Vaccinated Adults with and Without Booster Doses During Periods of Delta and Omicron Variant Emergence – 25 U.S. Jurisdictions, April 4-December 25, 2021. MMWR Morb Mortal Wkly Rep. 2022;71(4):132-138. PubMed PMID: 35085223.

Thompson MG, Natarajan K, Irving SA, Rowley EA, Griggs EP, Gaglani M, et al. Effectiveness of a Third Dose of mRNA Vaccines Against COVID-19-Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults During Periods of Delta and Omicron Variant Predominance – VISION Network, 10 States, August 2021-January 2022. MMWR Morb Mortal Wkly Rep. 2022;71(4):139-145. PubMed PMID: 35085224.

https://www.inesss.qc.ca/covid-19.html

Ordonnance individuelle préimprimée – Usage de nirmatrelvir/ritonavir (Paxlovid^MC) chez l’adulte (inesss.qc.ca)

[Product Monograph Template – Standard] (pfizer.ca)

Liverpool COVID-19 Interactions (covid19-druginteractions.org)

Infectious Diseases & Clinical Care Archives – Ontario COVID-19 Science Advisory Table (covid19-sciencetable.ca)

https://first10em.com

Autres articles d’intérêt

Ali K, Azher T, Baqi M, Binnie A, Borgia S, Carrier FM, et al. Remdesivir for the treatment of patients in hospital with COVID-19 in Canada: a randomized controlled trial. CMAJ. 2022. Epub 2022/01/21. doi: 10.1503/cmaj.211698. PubMed PMID: 35045989.

Ramacciotti E, Barile Agati L, Calderaro D, Aguiar VCR, Spyropoulos AC, de Oliveira CCC, et al. Rivaroxaban versus no anticoagulation for post-discharge thromboprophylaxis after hospitalisation for COVID-19 (MICHELLE): an open-label, multicentre, randomised, controlled trial. Lancet. 2022;399(10319):50-9. PubMed PMID: 34921756.

Clemency BM, Varughese R, Gonzalez-Rojas Y, Morse CG, Phipatanakul W, Koster DJ, Blaiss MS. Efficacy of Inhaled Ciclesonide for Outpatient Treatment of Adolescents and Adults With Symptomatic COVID-19: A Randomized Clinical Trial. JAMA Intern Med. 2022;182(1):42-49. PubMed PMID: 34807241

Berger JS, Kornblith LZ, Gong MN, Reynolds HR, Cushman M, Cheng Y, et al. Effect of P2Y12 Inhibitors on Survival Free of Organ Support Among Non-Critically Ill Hospitalized Patients With COVID-19: A Randomized Clinical Trial. JAMA. 2022;327(3):227-36. PubMed PMID: 35040887.

Ytterberg SR, Bhatt DL, Mikuls TR, Koch GG, Fleischmann R, Rivas JL, et al. Cardiovascular and Cancer Risk with Tofacitinib in Rheumatoid Arthritis. N Engl J Med. 2022;386(4):316-26. PubMed PMID: 35081280.

Feuerstadt P, Louie TJ, Lashner B, Wang EEL, Diao L, Bryant JA, et al. SER-109, an Oral Microbiome Therapy for Recurrent Clostridioides difficile Infection. N Engl J Med. 2022;386(3):220-9. PubMed PMID: 35045228.

Deardorff WJ, Cenzer I, Nguyen B, Lee SJ. Time to Benefit of Bisphosphonate Therapy for the Prevention of Fractures Among Postmenopausal Women With Osteoporosis: A Meta-analysis of Randomized Clinical Trials. JAMA Intern Med. 2022;182(1):33-41. PubMed PMID: 34807231.

Guides de pratique

American Diabetes Association Professional Practice C, American Diabetes Association Professional Practice C, Draznin B, Aroda VR, Bakris G, Benson G, et al. Summary of Revisions: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022;45(Supplement_1):S4-S7. PubMed PMID: 34964881.

Katz PO, Dunbar KB, Schnoll-Sussman FH, Greer KB, Yadlapati R, Spechler SJ. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol. 2022;117(1):27-56. PubMed PMID: 34807007.

Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(3):e4-e17. PubMed PMID: 34882436.

Capsule méthodologique

Wallach JD, Sullivan PG, Trepanowski JF, Sainani KL, Steyerberg EW, Ioannidis JP. Evaluation of Evidence of Statistical Support and Corroboration of Subgroup Claims in Randomized Clinical Trials. JAMA Intern Med. 2017;177(4):554-560. PubMed PMID: 28192563

Sleight P. Debate: Subgroup analyses in clinical trials: fun to look at – but don’t believe them! Curr Control Trials Cardiovasc Med. 2000;1(1):25-27. PubMed PMID: 11714402

Sun X, Briel M, Busse JW, You JJ, et al. The influence of study characteristics on reporting of subgroup analyses in randomised controlled trials: systematic review. BMJ. 2011;342:d1569. PubMed PMID: 21444636

Yusuf S, Wittes J, Probstfield J, Tyroler HA. Analysis and interpretation of treatment effects in subgroups of patients in randomized clinical trials. JAMA. 1991;266(1):93-8. PubMed PMID: 2046134

Références du quiz clinique

Diabetes Canada | Clinical Practice Guidelines – Renal Dosing Chart