Paxlovid significantly lowers risk of COVID hospitalization and death among vaccinated elders
According to a large study antiviral drug, Paxlovid lowers the risk of COVID-19-related hospitalization or death by 44% in a highly vaccinated group of US adults aged 50 and older. The study has been published in the Annals of Internal Medicine.
In the EPIC-HR (Evaluation of Protease Inhibition for Covid-19 in High-Risk Patients) trial, nirmatrelvir plus ritonavir led to an 89% reduction in hospitalization or death among unvaccinated outpatients with early COVID-19. The clinical impact of nirmatrelvir plus ritonavir among vaccinated populations is uncertain.
A study was conducted to assess whether nirmatrelvir plus ritonavir reduces risk for hospitalization or death among outpatients with early COVID-19 in the setting of prevalent SARS-CoV-2 immunity and immune-evasive SARS-CoV-2 lineages.
Population-based cohort study analyzed to emulate a clinical trial using inverse probability–weighted models to account for anticipated bias in treatment. A large health care system providing care for 1.5 million patients in Massachusetts and New Hampshire during the Omicron wave (1 January to 17 July 2022). 44 551 nonhospitalized adults (90.3% with ≥3 vaccine doses) aged 50 years or older with COVID-19 and no contraindications for nirmatrelvir plus ritonavir. The primary outcome was a composite of hospitalization within 14 days or death within 28 days of a COVID-19 diagnosis.
Results:
• During the study period, 12 541 (28.1%) patients were prescribed nirmatrelvir plus ritonavir, and 32 010 (71.9%) were not.
• Patients prescribed nirmatrelvir plus ritonavir were more likely to be older, have more comorbidities, and be vaccinated.
• The composite outcome of hospitalization or death occurred in 69 (0.55%) patients who were prescribed nirmatrelvir plus ritonavir and 310 (0.97%) who were not
• Recipients of nirmatrelvir plus ritonavir had lower risk for hospitalization and death
The overall risk for hospitalization or death was already low (1%) after an outpatient diagnosis of COVID-19, but nirmatrelvir plus ritonavir reduced this risk further.
Reference:
Scott Dryden-Peterson, Andy Kim, Arthur Y. Kim, et al. Nirmatrelvir Plus Ritonavir for Early COVID-19 in a Large U.S. Health System: A Population-Based Cohort Study. Ann Intern Med. [Epub 13 December 2022]. doi:10.7326/M22-2141
