Effectiveness and Safety of Nirmatrelvir/Ritonavir (Paxlovid) Versus Remdesivir in Covid-19: A Systematic Review and Meta-Analysis of Retrospective Studies Publisher



Akbarzadeh A ; Razeghian M ; Hajiabadi F ; Dehghan P ; Ahmadi Mazhin S ; Eshaghzadeh M ; Poursadeqiyan M ; Shabestan R
Source: Health Science Reports Published:2026

Abstract

Background and Aim: Nirmatrelvir/ritonavir (Paxlovid) and remdesivir are antiviral agents that have been widely used in the management of patients with Coronavirus disease 2019 (COVID-19). This systematic review and meta-analysis were conducted to compare the clinical effectiveness and safety outcomes of Paxlovid and remdesivir among patients with COVID-19. Methods: A systematic search was performed across the Cochrane Library, Web of Science, PubMed, and medRxiv from inception to July 2024. Data from the identified studies were analyzed using Comprehensive Meta-Analysis (CMA) software. Results: Thirteen studies involving 4583 patients were included in the final analysis. Compared with remdesivir, Paxlovid was associated with a significant reduction in mortality (odds ratio [OR] = 0.36, 95% confidence interval [CI]: 0.18–0.73), time to SARS-CoV-2 negative conversion (standardized mean differences [SMD] = −1.44, 95% CI: −1.54 to −1.33), hospitalization (OR = 0.34, 95% CI: 0.16–0.74), intensive care unit admission (OR = 0.10, 95% CI: 0.01–0.53), and the need for oxygen therapy (OR = 0.06, 95% CI: 0.02–0.16). No statistically significant difference was observed between the two treatments regarding polymerase chain reaction negativity rate (OR = 1.45, 95% CI: 0.73–2.86). However, adverse events were higher among patients receiving Paxlovid (OR = 6.60, 95% CI: 3.24–13.42). The certainty of evidence for the evaluated outcomes ranged from low to moderate. Conclusion: In patients with COVID-19, Paxlovid may offer potential benefits over remdesivir for certain clinical outcomes, though it may also be accompanied by a higher rate of adverse events. These findings are based on retrospective studies, which carry risks of selection bias, confounding, and heterogeneity. © 2026 The Author(s). Health Science Reports published by Wiley Periodicals LLC.