Nirmatrelvir reduces likelihood of development of long COVID when given in 1st week of infection

A new study by Yan Xie and team showed that intervention with nirmatrelvir within five days of a positive SARS-CoV-2 test was linked to a reduced likelihood of Post–COVID-19 condition (PCC) across the risk spectrum in this cohort, irrespective of vaccination status or history of prior infection in people with SARS-CoV-2 infection who had at least one risk factor for progression to severe disease.

The findings of this study were published in JAMA Internal Medicine. 

Post–COVID-19 condition, also referred to as long-term COVID, affects many individuals. Prevention of PCC is a critical public health issue. In order to determine whether nirmatrelvir treatment during the acute phase of COVID-19 is linked to a lower risk of PCC, this study was carried out.

In this cohort study, patients who tested positive for SARS-CoV-2 between January 3, 2022, and December 31, 2022, who were not hospitalized on the day of the positive test result, who had at least one risk factor for developing severe COVID-19 illness, and who had survived the first 30 days following SARS-CoV-2 diagnosis, were identified. It was possible to distinguish between those who received oral nirmatrelvir treatment within five days of the positive test (n = 35 717) and those who did not receive COVID-19 antiviral or antibody treatment throughout the acute phase of SARS-CoV-2 infection (control group, n = 246 076).

Nirmatrelvir's (vs. control) relationship with post-acute hospitalization, post-acute mortality, and a predetermined panel of 13 post-acute COVID-19 sequelae (components of PCC) was estimated using inverse probability weighted survival models. Results were provided in relative scale as relative risk (RR) or hazard ratio (HR), and in absolute scale as absolute risk reduction in % after 180 days (ARR).

The key findings of this study were:

A total of 281,793 patients who tested positive for SARS-CoV-2 and had at least one risk factor for progression to severe COVID-19 disease were studied. 

Of these, 246,076 did not receive antiviral or antibody treatment for COVID-19 during the acute phase of SARS-CoV-2 infection, and 35,717 received oral nirmatelvir within five days of a positive SARS-CoV-2 test result. 

Compared with the control group, nimatrelvir was associated with a reduced risk of PCC, including 10 of 13 acute sequelae (PCC components) in the cardiovascular system, coagulation and hematological disorders, fatigue and malaise, and acute kidney disease. , muscle disease pain, neurological system and shortness of breath. 

Nirmatrelvir was also associated with a reduced risk of acute death and acute hospitalization. 

The use of nirmatrelvir was associated with a reduced risk of PCC in unvaccinated, vaccinated and boosted primary SARS-CoV-2 infection and reinfection.

Reference: 

Xie, Y., Choi, T., & Al-Aly, Z. (2023). Association of Treatment With Nirmatrelvir and the Risk of Post–COVID-19 Condition. In JAMA Internal Medicine. American Medical Association (AMA). https://doi.org/10.1001/jamainternmed.2023.0743