Paxlovid Lowers Long-Term Stroke and Death Risk in COVID Patients, confirms study
Researchers have discovered in a new study that using Paxlovid (nirmatrelvir/ritonavir) early in the course of mild-to-moderate COVID-19 can substantially lower the long-term risk of stroke and death. The research conducted on more than 180,000 patients in the United States, revealed individuals who were administered Paxlovid within five days of a COVID-19 diagnosis experienced reduced rates of ischemic and hemorrhagic stroke. The study was conducted by Cheng-Hsun and colleagues published in the Journal of Medical Virology.
This large retrospective cohort study employed data from the TriNetX electronic health record database among 118 million patients across the United States. Adults aged 18 years and older who were diagnosed with COVID-19 in 2022 and 2023 were included in the analysis. Patients were categorized into two groups: those who received Paxlovid within five days of diagnosis and those who did not receive Paxlovid.
To ascertain the validity of the results, patients with prior cerebrovascular disease, early death (within 3 months), other antiviral treatment, or serious disease necessitating ICU admission or respiratory therapy were excluded. This would allow us to distinguish the effect of Paxlovid on long-term outcomes from that of severe underlying illness or treatments.
The analysis date for the analysis was the diagnosis date of COVID-19. A strong 1:1 propensity score match was employed to establish two equally matched groups to compare. Analysis of outcomes using Kaplan–Meier survival curve and Cox proportional hazards models evaluated the risk of stroke and death after more than 90 days since initial infection.
Key Findings
Analysis was conducted using 181,992 matched patient pairs, setting a solid base for comparison. The findings included:
A 15% lower risk of ischemic or hemorrhagic stroke in the Paxlovid group during the long COVID period (Hazard Ratio [HR]: 0.85; 95% Confidence Interval [CI]: 0.80–0.89).
A 32% reduced risk of all-cause mortality among Paxlovid users at 90 days after infection (HR: 0.68; 95% CI: 0.63–0.73).
The benefits were observed in all the various subgroups such as age, sex, body mass index, and prior conditions such as hypertension, diabetes, and hyperlipidemia.
In the older population, the stroke risk was also decreased (HR: 0.81; 95% CI: 0.76–0.86).
Among obese subjects, the protective effect persisted (Adjusted HR: 0.86; 95% CI: 0.78–0.96).
The effects were also present irrespective of immunization status, indicating that protection by Paxlovid was immunization-independent.
Paxlovid treatment during the acute phase of mild-to-moderate COVID-19 lowered the risk of ischemic and hemorrhagic stroke and all-cause mortality after more than 90 days following infection.These findings suggest that early antiviral treatment could be a protective measure against long COVID complications, with effects consistently being seen across age groups, health status, and vaccination status.
Reference:
Chuang, C.-H., Wang, Y.-H., Yeh, L.-T., & Yeh, C.-B. (2025). Long-term stroke and mortality risk reduction associated with acute-phase Paxlovid use in mild-to-moderate COVID-19. Journal of Medical Virology, 97(4), e70351. https://doi.org/10.1002/jmv.7035
