Paxlovid may reduce all-cause mortality in pediatric patients with SARS-CoV-2 infection: Study

A recent study published in the Nature Communications addressed the significant gap in data regarding the use of the antiviral combination nirmatrelvir/ritonavir for pediatric patients infected with SARS-CoV-2. This newly conducted target trial emulation study provides critical insights into the effectiveness and safety of the antiviral medication in non-hospitalized children of 12 to 17 years old who contracted the Omicron variant of COVID-19.

The study evaluated pediatric patients diagnosed with SARS-CoV-2 from March 16, 2022 to February 5, 2023. The patients were considered exposed if they received outpatient treatment with nirmatrelvir/ritonavir within five days of symptom onset or a COVID-19 diagnosis. The primary outcome measured was the 28-day all-cause mortality or hospitalization, while secondary outcomes included 28-day in-hospital disease progression, COVID-19-specific hospitalization, multisystem inflammatory syndrome in children (MIS-C), acute liver injury, acute renal failure and acute respiratory distress syndrome.

A total of 49,378 eligible pediatric patients were included in this comprehensive study. The findings suggest that nirmatrelvir/ritonavir treatment was significantly associated with a reduction in 28-day all-cause hospitalization. Also, the absolute risk reduction was 0.23% (with a 95% confidence interval of 0.19% to 0.31%) and the relative risk was 0.66 (with a 95% confidence interval of 0.56 to 0.71). There were no observed events of mortality, in-hospital disease progression or adverse clinical outcomes among the patients treated with nirmatrelvir/ritonavir.

These results underline the potential of nirmatrelvir/ritonavir to significantly reduce the hospitalization risks for non-hospitalized pediatric patients infected with the Omicron variant of COVID-19. The antiviral therapy appears to provide a robust defense against severe outcomes in children and adolescents, thereby offering a valuable tool in managing the ongoing pandemic.

The study highlights the importance of timely intervention, as the efficacy of the treatment was assessed based on administration within five days of symptom onset or diagnosis. This suggests that early outpatient treatment could be key in reducing severe disease progression in pediatric COVID-19 cases.

Research like these is critical in shaping effective treatment protocols and ensuring that vulnerable populations, including children and adolescents, receive the best possible care. The findings of this study could pave way for further research and potentially wider use of nirmatrelvir/ritonavir in pediatric COVID-19 treatment to reduce the burden of the disease on younger populations.

Reference:

Wong, C. K. H., Lau, K. T. K., Au, I. C. H., Chan, S. H. S., Lau, E. H. Y., Cowling, B. J., & Leung, G. M. (2024). Effectiveness of nirmatrelvir/ritonavir in children and adolescents aged 12–17 years following SARS-CoV-2 Omicron infection: A target trial emulation. In Nature Communications (Vol. 15, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1038/s41467-024-49235-8