前言
很多人让我写新冠肺炎怎么治疗。
怎么治疗，买不到药么，写了有什么用。
从文献看，帕克洛维（奈玛特韦片/利托那韦片(Paxlovid)），效果还是很好的，并且目前有多项研究证实可以明显降低死亡率，减少住院。
从别人的有限经验看，效果也不错。
既然药物有效，为什么不提前准备好药物给老百姓？
不说了......
文献
荟萃分析显示，奈玛特韦片/利托那韦片(Paxlovid)可以降低88%的死亡率！
我觉得，没有那么夸张，但是也可以说明，这个药效果非常好。
下面是文章内容，可以略过。
Zheng Q, Ma P, Wang M, Cheng Y, Zhou M, Ye L, Feng Z, Zhang C. Efficacy and safety of Paxlovid for COVID-19:a meta-analysis. J Infect. 2023 Jan;86(1):66-117. doi: 10.1016/j.jinf.2022.09.027. Epub 2022 Sep 30. PMID: 36191676; PMCID: PMC9523907.
To the Editor:
We read with interest a recent article reported by Wang Y et al. 1. The authors reported a case of COVID-19 rebound in a severe COVID-19 patient during long term (20 days) treatment of Paxlovid. Paxlovid is a recommended treatment for mild-moderate COVID-19 and risk factors for severe disease. With wide-spread use of Paxlovid, there have been case reports of individuals experiencing virologic rebound. Hence, meta-analysis of the efficiency and safety of Paxlovid in patients with COVID-19 is of great importance.
编辑你好，我们想给你写封信！
An extensive literature search was performed in PubMed, Web of Science, EMBASE, and Cochrane Library to find all for relevant studies published from December 1, 2021, to September 20, 2022. We screened the references of the retrieved studies and restricted the language of the search to English. Following keywords were used in the search: Paxlovid (nirmatrelvir/ritonavir) and COVID-19 (SARS-CoV-2, SARS2, SARS Coronavirus 2, Coronavirus Disease 2019, 2019-nCoV, 2019 Novel Coronavirus). The inclusion criteria were as follows: (1) the article reported the clinical results of Paxlovid, including the total number of participants and the specific number of deaths, hospitalization, rebound or adverse events; (2) English language. The exclusion criteria were as follows: (1) irrelevant to the research direction, (2) no relevant data, (3) case reports, (4) review papers, (5) repeated articles.
我们看了很多文献！
在PubMed、Web of Science、EMBASE和Cochrane Library中进行了广泛的文献搜索，以查找2021 12月1日至2022年9月20日期间发表的相关研究的所有信息。我们筛选了检索到的研究的参考文献，并将搜索语言限制为英语。搜索中使用了以下关键词：帕克索维德（尼玛曲韦/利托那韦）和新冠肺炎（SARS-CoV-2、SARS2、SARS冠状病毒2、冠状病毒病2019、2019-nCoV、2019新型冠状病毒）。纳入标准如下：（1）文章报告了Paxlovid的临床结果，包括参与者总数和死亡、住院、反弹或不良事件的具体数量；（2） 英语。排除标准如下：（1）与研究方向无关，（2）无相关数据，（3）病例报告，（4）综述论文，（5）重复文章。
The analysis was conducted using the Review Manager statistical software, version 5.3. A binary controlled study was used to calculate the number of deaths, hospitalization, rebound or adverse events. Odds ratio (OR) and 95% confidence interval (CI) were used to assess the effect in a whole random-effects meta-analysis model. The I2 and P value was used to quantify the heterogeneity of the effects among the included studies.
使用Review Manager统计软件5.3版进行分析。
A total of 13 studies involving 186,306 patients were identified in the final analysis, and the detail of the included studies are shown in Table 12, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14. Three studies described the rebound of COVID-19 patients in Paxlovid group and control group. The overall OR of rebound among COVID-19 patients in the Paxlovid vs. control group was 0.99 (95% CI, 0.28–3.57; I2 =59%), P = 0.99 (Fig. 1A). Five studies described adverse events in Paxlovid group and control group. The overall OR of adverse events among COVID-19 patients in the Paxlovid vs. control group was 1.07 (95% CI, 0.49–2.34; I2 =90%), P = 0.87 (Fig. 1B). There is no significant difference of rebound and adverse events in Paxlovid group and control group.
13项研究，18.6万例患者。
最终分析共确定了涉及186306名患者的13项研究，表12、3、4、5、6、7、8、9、10、11、12、13、14显示了纳入研究的详情。三项研究描述了Paxlovid组和对照组中新冠肺炎患者的反弹情况。Paxlovid组与对照组中新冠肺炎患者反弹的总OR为0.99（95%CI，0.28-3.57；I2=59%），P=0.99（图1A）。五项研究描述了Paxlovid组和对照组的不良事件。Paxlovid组与对照组中新冠肺炎患者的不良事件总OR为1.07（95%CI，0.49-2.34；I2=90%），P=0.87（图1B）。Paxlovid组和对照组的反弹和不良事件无显著性差异。
In addition, we analyze the efficacy of Paxlovid on death and hospitalization for COVID-19 patients. Seven studies described the death of COVID-19 patients in the Paxlovid group and control group, and seven studies described the hospitalization of COVID-19 patients. Our study showed that the overall OR for death and hospitalization among COVID-19 patients in the Paxlovid vs. control group was 0.22 (95% CI, 0.11–0.45; I2 =93%), P <0.0001. The result indicates that the Paxlovid treatment is effective for patients with COVID-19, reducing the mortality or hospitalization rate by 78% (Fig. 1). Subtype analysis shows that the OR of mortality for COVID-19 patients in the Paxlovid vs. control group was 0.12 (95% CI, 0.04–0.36; I2 =42%), P = 0.0001, indicating an 88% reduction in mortality. The OR of hospitalization for COVID-19 patients in the Paxlovid vs. control group was 0.32 (95% CI, 0.13–0.75; I2 =95%), P = 0.009, a 68% reduction in hospitalization rate.
此外，我们分析了帕克洛韦对新冠肺炎患者死亡和住院的疗效。七项研究描述了帕克洛韦组和对照组中新冠肺炎患者的死亡，七项研究说明了新冠肺炎患者的住院情况。我们的研究表明，帕克洛韦组与对照组新冠肺炎患者的死亡和住院总OR为0.22（95%CI，0.11-0.45；I2=93%），P<0.0001。结果表明，帕克洛韦治疗对新冠肺炎患者有效，可将死亡率或住院率降低78%（图1）。亚型分析表明，帕克洛韦组与对照组相比，新冠肺炎患者的死亡率OR为0.12（95%CI，0.04-0.36；I2=42%），P=0.0001，表明死亡率降低了88%。Paxlovid组与对照组相比，新冠肺炎患者的住院优势比为0.32（95%CI，0.13-0.75；I2=95%），P=0.009，住院率降低68%。
In conclusion, our research shows that Paxlovid for COVID-19 is effective and safe. COVID-19 rebound is not unique to Paxlovid. There is no significant difference of rebound in Paxlovid group and control group. There has been more attention to COVID-19 rebounds following Paxlovid treatment, which may be attributable to more people being treated with Paxlovid. However, the phenomenon of rebounds following Paxlovid treatment reinforces the importance of testing for individuals with recurrent symptoms after Paxlovid treatment.
总之，我们的研究表明，帕克洛韦治疗新冠肺炎是有效和安全的。新冠肺炎的反弹并不是帕克索维德独有的。Paxlovid组与对照组的回弹无显著性差异。帕克洛维德治疗后，人们对新冠肺炎疫情反弹的关注度更高，这可能是因为更多的人接受了帕克洛维治疗。然而，Paxlovid治疗后的反弹现象加强了对Paxlovid治疗后复发症状患者进行检测的重要性。
This work was supported by Science and Technology Fund of Guizhou Health Commission (No.gzwkj2021-024), and the cultivate project 2021 for National Natural Science Foundation of China, Affiliated Hospital of Guizhou Medical University (No.gyfynsfc-2021-14).
All authors report that they have no potential conflicts of interest.
网址：https://www.sciencedirect.com/science/article/pii/S0163445322005576
另外一篇：Wen W, Chen C, Tang J, et al. Efficacy and safety of three new oral antiviral treatment (molnupiravir, fluvoxamine and Paxlovid) for COVID-19：a meta-analysis. Ann Med. 2022;54(1):516-523. doi:10.1080/07853890.2022.2034936
The overall odds ratio (OR) of mortality or hospitalization was 0.33 (95% confidence interval [CI], 0.22-0.49) for COVID-19 patients in the drug group and placebo group, indicating that oral antiviral drugs were effective for COVID-19 patients and reduced the mortality or hospitalization by approximately 67%.
表明口服抗病毒药物对新冠肺炎患者有效，并将死亡率或住院时间减少了约67%。
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《暴走大事件 第6季》第10期：古装剧平行宇宙大乱斗
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