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Last Updated: July 12, 2025

CLINICAL TRIALS PROFILE FOR NIRMATRELVIR; RITONAVIR


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All Clinical Trials for Nirmatrelvir; Ritonavir

Trial ID Title Status Sponsor Phase Start Date Summary
NCT05261139 ↗ EPIC-Peds: Study of Oral PF-07321332 (Nirmatrelvir)/Ritonavir in Nonhospitalized COVID-19 Pediatric Patients at Risk for Severe Disease Not yet recruiting Pfizer Phase 3 2022-03-02 The purpose of the study is to evaluate the safety, pharmacokinetics, and efficacy of nirmatrelvir/ritonavir for the treatment of nonhospitalized, symptomatic pediatric participants with coronavirus disease 2019 (COVID-19) who are at risk of progression to severe disease.
NCT05321394 ↗ Non-inferiority Trial on Treatments in Early COVID-19 Recruiting Agenzia Italiana del Farmaco Phase 3 2022-03-07 The study aims at assessing the non-inferiority of tixagevimab plus cilgavimab and nirmatrelvir plus ritornavir vs. sotrovimab (reference standard due to the wider evidence gathered on its efficacy) on COVID-19 progression in a real-life setting of outpatients aged at least 50 years at an early stage of the disease. The progression of COVID-19 disease (hospitalization, need for supplementary oxygen therapy at home, death) within 14 days of randomisation is the composite outcome variable on which the calculation of the sample size is based. Based on available data regarding the reduction in the number of hospitalisations and medical visits with the use of sotrovimab at an early-stage of COVID-19, a disease progression of 1% has been estimated in the reference arm. 3% delta margin was considered clinically relevant, taking into account both the estimates of disease progression in the study population in absence of early treatment (7%, based on national data) and the efficacy of the reference standard. Therefore, 1095 participants will be randomly assigned in an equal ratio between the reference standard and each of the other two experimental arms (1:1:1). Randomization will be computer-generated in permuted blocks with a stratification based on site.
NCT05321394 ↗ Non-inferiority Trial on Treatments in Early COVID-19 Recruiting Azienda Sanitaria-Universitaria Integrata di Udine Phase 3 2022-03-07 The study aims at assessing the non-inferiority of tixagevimab plus cilgavimab and nirmatrelvir plus ritornavir vs. sotrovimab (reference standard due to the wider evidence gathered on its efficacy) on COVID-19 progression in a real-life setting of outpatients aged at least 50 years at an early stage of the disease. The progression of COVID-19 disease (hospitalization, need for supplementary oxygen therapy at home, death) within 14 days of randomisation is the composite outcome variable on which the calculation of the sample size is based. Based on available data regarding the reduction in the number of hospitalisations and medical visits with the use of sotrovimab at an early-stage of COVID-19, a disease progression of 1% has been estimated in the reference arm. 3% delta margin was considered clinically relevant, taking into account both the estimates of disease progression in the study population in absence of early treatment (7%, based on national data) and the efficacy of the reference standard. Therefore, 1095 participants will be randomly assigned in an equal ratio between the reference standard and each of the other two experimental arms (1:1:1). Randomization will be computer-generated in permuted blocks with a stratification based on site.
NCT05321394 ↗ Non-inferiority Trial on Treatments in Early COVID-19 Recruiting Azienda Ospedaliera Universitaria Integrata Verona Phase 3 2022-03-07 The study aims at assessing the non-inferiority of tixagevimab plus cilgavimab and nirmatrelvir plus ritornavir vs. sotrovimab (reference standard due to the wider evidence gathered on its efficacy) on COVID-19 progression in a real-life setting of outpatients aged at least 50 years at an early stage of the disease. The progression of COVID-19 disease (hospitalization, need for supplementary oxygen therapy at home, death) within 14 days of randomisation is the composite outcome variable on which the calculation of the sample size is based. Based on available data regarding the reduction in the number of hospitalisations and medical visits with the use of sotrovimab at an early-stage of COVID-19, a disease progression of 1% has been estimated in the reference arm. 3% delta margin was considered clinically relevant, taking into account both the estimates of disease progression in the study population in absence of early treatment (7%, based on national data) and the efficacy of the reference standard. Therefore, 1095 participants will be randomly assigned in an equal ratio between the reference standard and each of the other two experimental arms (1:1:1). Randomization will be computer-generated in permuted blocks with a stratification based on site.
NCT05386472 ↗ A Study to Learn About the Study Medicine (Called Nirmatrelvir/Ritonavir) in Pregnant Women With Mild or Moderate COVID-19. Not yet recruiting Pfizer Phase 1 2022-06-23 The purpose of this clinical trial is to learn about how study medicine (Paxlovid, which contains nirmatrelvir and ritonavir) is changed and eliminated from the body, as well as its safety, and the extent to which side effects can be tolerated for treatment of pregnant women with mild or moderate COVID-19 compared to non-pregnant women with mild or moderate COVID-19. This study is seeking participants who: - are expecting a healthy baby and are in their second or third trimester pregnant and have mild or moderate COVID-19 - are not pregnant and have mild or moderate COVID-19. All participants in this study will take Paxlovid by mouth every 12 hours for 5 days (10 doses total). We will examine the experiences of people receiving the study medicine. This will help us determine if the study medicine is safe. All participants will take part in this study for at least 34 days; pregnant participants will take part until their delivery, so that the study duration may be up to 6 months, depending on their delivery date. During this time, participants will have 7-8 visits and, if pregnant, a visit at delivery. 2-3 visits and the delivery visit will be done in person (at the clinic or at the participant's home). The other 5 visits may be done over the phone, unless an in-person visit is necessary as determined by the investigator. Blood samples will be collected on the first 4-5 study visits (and at other study visits, if necessary). Some blood samples may be taken by participants themselves.
NCT05438602 ↗ A Study to Learn About the Study Medicines (Called Nirmatrelvir/Ritonavir) in People 12 Years Old or Older With COVID-19 Who Are Immunocompromised Not yet recruiting Pfizer Phase 2 2022-07-29 Patients with COVID-19 who are immunocompromised have a higher chance of severe illness. Such patients may benefit from longer treatment durations compared to the standard treatment regimen. The purpose of the clinical trial is to evaluate the efficacy (how well a study treatment works in the clinical trial) and safety when taking the study medicine for either 5, 10, or 15 days. All the study medication will be taken by mouth. The first dose of study medication is taken at the study site and the rest at home. People taking part will be in this study for about 24 weeks. Enrolled participants will need to visit the study site at least 10 times during the study.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for Nirmatrelvir; Ritonavir

Condition Name

Condition Name for Nirmatrelvir; Ritonavir
Intervention Trials
COVID-19 11
Long COVID 3
Biological Availability 2
Post COVID-19 Condition, Unspecified 2
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Condition MeSH

Condition MeSH for Nirmatrelvir; Ritonavir
Intervention Trials
COVID-19 13
Coronavirus Infections 1
Tachycardia 1
Syndrome 1
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Clinical Trial Locations for Nirmatrelvir; Ritonavir

Trials by Country

Trials by Country for Nirmatrelvir; Ritonavir
Location Trials
United States 5
China 2
Russian Federation 1
Sweden 1
Egypt 1
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Trials by US State

Trials by US State for Nirmatrelvir; Ritonavir
Location Trials
North Carolina 1
Connecticut 1
Texas 1
South Carolina 1
Mississippi 1
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Clinical Trial Progress for Nirmatrelvir; Ritonavir

Clinical Trial Phase

Clinical Trial Phase for Nirmatrelvir; Ritonavir
Clinical Trial Phase Trials
Phase 4 2
Phase 3 4
Phase 2/Phase 3 1
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Clinical Trial Status

Clinical Trial Status for Nirmatrelvir; Ritonavir
Clinical Trial Phase Trials
Not yet recruiting 15
Recruiting 3
Completed 2
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Clinical Trial Sponsors for Nirmatrelvir; Ritonavir

Sponsor Name

Sponsor Name for Nirmatrelvir; Ritonavir
Sponsor Trials
Pfizer 12
China National Center for Cardiovascular Diseases 1
Haukeland University Hospital 1
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Sponsor Type

Sponsor Type for Nirmatrelvir; Ritonavir
Sponsor Trials
Other 19
Industry 14
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Nirmatrelvir-Ritonavir: Clinical Trials Update, Market Analysis, and Projections

Last updated: January 1, 2025

Introduction

Nirmatrelvir-ritonavir, an oral antiviral treatment, has been a significant development in the fight against COVID-19. Here, we will delve into the latest clinical trials, market analysis, and projections for this drug.

Clinical Trials Update

Efficacy in COVID-19 Treatment

Nirmatrelvir-ritonavir has been extensively studied for its efficacy in treating mild to moderate COVID-19. Clinical trials have shown that this combination significantly reduces the risk of hospitalization and death in high-risk, unvaccinated individuals. A phase 2/3 study conducted across 21 countries demonstrated that nirmatrelvir-ritonavir reduced COVID-19-related hospitalizations and all-cause deaths, and also shortened the duration of symptoms and medical visits[4].

Real-World Effectiveness

Real-world studies have reinforced these findings. For instance, a study in Israel showed a 63% reduction in COVID-19-related hospitalizations among high-risk individuals aged 65 and older treated with nirmatrelvir-ritonavir. Similar reductions were observed in other studies conducted in the US and Hong Kong, with effectiveness ranging from 45% to 54% in reducing hospital admissions[5].

Postacute Sequelae of SARS-CoV-2 (PASC)

A recent clinical trial, STOP-PASC, investigated the use of nirmatrelvir-ritonavir in treating PASC symptoms. However, the trial found that a 15-day course of nirmatrelvir-ritonavir did not significantly improve symptoms such as fatigue, brain fog, body aches, cardiovascular symptoms, shortness of breath, or gastrointestinal symptoms in mostly vaccinated adults with PASC[1].

Safety and Side Effects

While nirmatrelvir-ritonavir has been generally safe, there are concerns about potential drug interactions and toxicity. The drug can interact with other medications due to ritonavir's inhibition of the CYP3A4 enzyme, and there is a risk of rebound infections and symptoms in up to 27% of patients[3].

Market Analysis

Sales and Revenue

Nirmatrelvir-ritonavir has been a commercial success, with estimated sales of $19 billion in 2022 and $8 billion in 2023. Despite declining effectiveness in highly vaccinated populations, the drug remains widely used[2].

Cost-Effectiveness

The cost-effectiveness of nirmatrelvir-ritonavir is a subject of ongoing debate. Studies suggest that while the drug is effective in reducing hospitalizations and deaths, its use may not be cost-effective in the general population, especially with high vaccination rates. A cost-effectiveness analysis using a decision-analytic model highlighted the need for targeted prescription strategies based on risk and vaccination status[3].

Market Projections

Future Use and Indications

Given the evolving landscape of COVID-19 and vaccination rates, the indications for nirmatrelvir-ritonavir may need to be reassessed. While the drug has been approved for use in high-risk, unvaccinated individuals, its effectiveness in vaccinated populations is lower. Future studies may focus on optimizing treatment strategies for different patient groups[3].

Competition and Alternatives

The market for COVID-19 treatments is competitive, with other antivirals like molnupiravir and remdesivir also available. Molnupiravir, for example, has shown mixed results in terms of cost-effectiveness and efficacy, particularly in vaccinated populations. The choice between these treatments will depend on ongoing research and real-world data[2].

Regulatory Status

Emergency Use Authorization and Full Approval

Nirmatrelvir-ritonavir received Emergency Use Authorization (EUA) from the US FDA on December 22, 2021, and was fully approved on May 25, 2023. This regulatory status reflects the drug's proven efficacy in reducing severe outcomes in high-risk patients[2].

Real-World Impact

Public Health Implications

The widespread use of nirmatrelvir-ritonavir has significant public health implications. Studies have shown that early treatment with this drug can reduce the burden on healthcare systems by decreasing hospital admissions. This is particularly important during waves of new variants, such as the omicron wave, where the drug has been shown to be effective even in vaccinated populations[5].

Key Takeaways

  • Clinical Efficacy: Nirmatrelvir-ritonavir is effective in reducing hospitalizations and deaths in high-risk, unvaccinated individuals with COVID-19.
  • PASC Treatment: The drug does not significantly improve PASC symptoms.
  • Market Performance: Despite declining effectiveness in vaccinated populations, the drug remains a commercial success.
  • Cost-Effectiveness: Targeted prescription strategies are necessary to ensure cost-effectiveness.
  • Future Directions: Ongoing research will focus on optimizing treatment strategies and assessing the drug's role in a highly vaccinated population.

FAQs

Q: What is the primary use of nirmatrelvir-ritonavir?

A: Nirmatrelvir-ritonavir is primarily used to treat mild to moderate COVID-19 in high-risk adults to prevent progression to severe disease.

Q: Has nirmatrelvir-ritonavir been effective in treating PASC symptoms?

A: No, a recent clinical trial found that nirmatrelvir-ritonavir did not significantly improve PASC symptoms such as fatigue, brain fog, and body aches.

Q: What are the potential side effects of nirmatrelvir-ritonavir?

A: The drug can cause serious drug interactions and toxicity due to ritonavir's inhibition of the CYP3A4 enzyme, and there is a risk of rebound infections and symptoms.

Q: How cost-effective is nirmatrelvir-ritonavir?

A: The cost-effectiveness of nirmatrelvir-ritonavir is questionable, especially in highly vaccinated populations. Targeted prescription strategies are recommended to ensure cost-effectiveness.

Q: What is the current market status of nirmatrelvir-ritonavir?

A: Despite declining effectiveness in vaccinated populations, nirmatrelvir-ritonavir remains a commercially successful drug with significant sales.

Sources

  1. JAMA Internal Medicine: "Nirmatrelvir-Ritonavir and Symptoms in Adults With Postacute Sequelae of SARS-CoV-2 Infection"[1]
  2. Open Forum Infectious Diseases: "Systematic Review of Nirmatrelvir/Ritonavir and Molnupiravir for the Treatment of COVID-19"[2]
  3. Open Forum Infectious Diseases: "Population-Level Strategies for Nirmatrelvir/Ritonavir Prescribing—A Cost-Effectiveness Analysis"[3]
  4. Clinical Infectious Diseases: "Alleviation of Coronavirus Disease 2019 Symptoms and Reduction in Hospitalization and Death with Nirmatrelvir/Ritonavir"[4]
  5. The Lancet Infectious Diseases: "Effectiveness of nirmatrelvir–ritonavir in preventing hospital admission or death in patients with COVID-19"[5]

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