Infectious Disease

Paxlovid associated with decreased hospitalization among adults with COVID-19

November 23, 2022

2 min read

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The authors report no relevant financial disclosures.

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New data published in an MMWR report showed that patients with COVID-19 given a prescription for Paxlovid had a lower rate of hospitalization.

“[Paxlovid], an oral antiviral treatment, is authorized for adults with mild-to-moderate COVID-19 who are at increased risk for progression to severe illness,” Melisa M. Shah, MD, epidemic intelligence officer in CDC’s National Center for Immunization and Respiratory Diseases , and colleagues wrote. “However, real-world evidence on the benefit of Paxlovid, according to vaccination status, age group, and underlying health conditions, is limited.”

IDN1122Shah_Graphic_01_WEB

Shah MM, et al. Morbid Mortal Wkly Rep MMWR. 2022;doi:10.15585/mmwr.mm7148e2.

To examine the potential benefit of Paxlovid in adults aged 18 years and older in the US, Shah and colleagues retrospectively analyzed a large electronic health record data set of more than 160 million people to assess the association between receiving Paxlovid and hospitalization with a COVID-19 diagnosis in the 30 days after.

According to the study, a Cox proportional hazards model was then used to estimate general association, as well as adjusted associations for demographic characteristics, geographic location, vaccination, previous infection and number of underlying health conditions.

In total, 699,848 people aged 18 years and older were eligible for Paxlovid between April and August 2022. Of these, 28.4% received a Paxlovid prescription within 5 days of COVID-19 diagnosis. The overall COVID-19 hospitalization rate among these patients was 51% lower.

According to the study, being prescribed Paxlovid was associated with a lower hospitalization rate among the overall study population (adjusted HR = 0.49; 95% CI, 0.46-0.53), as well as people who had received three or more messenger RNA vaccine doses ( aHR = 0.5; 95% CI, 0.45-0.55) and two mRNA vaccine doses (aHR = 0.5; 95% CI, 0.42-0.58). Additionally, the study showed that aHRs for specific age groups were 0.59 for those aged 18 to 49 years, 0.4 for those aged 50 to 64 years and 0.53 for those aged 65 years and older.

Specifically, among people aged 18 to 49 years, Paxlovid was associated with lower hospitalization rates among those who had received three or more mRNA vaccine doses (aHR = 0.75; 95% CI, 0.53-1.06) and those with only one underlying health condition ( aHR = 0.91; 95% CI, 0.58-1.44). An analysis of secondary outcomes also showed that among the overall study population, Paxlovid receipt was associated with a lower rate of all-cause hospitalization (aHR = 0.45; 95% CI, 0.43-0.48) and acute respiratory illness-associated hospitalization (aHR = 0.48; 95% CI, 0.45-0.51).

“This study demonstrates that Paxlovid provides protection against severe COVID-19-associated outcomes among persons for whom it is recommended, including those with vaccine-conferred immunity, and that it is underutilized among eligible persons with COVID-19,” the authors wrote. “Paxlovid should be offered to eligible persons to protect against COVID-19 hospitalizations, irrespective of vaccination status, and especially among groups with the highest risk for severe outcomes, such as older adults and those with multiple underlying health conditions.”

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