Use of Paxlovid for Treatment of Acute COVID-19 and Occurrence of Post-COVID Conditions among Children and Adults at High-Risk for Severe COVID-19, April 1 - December 31, 2022

Dalton et al., IDWeek 2023

Oct 2023

Retrospective 297,662 paxlovid patients in the USA, showing lower risk of post-COVID conditions for patients 50+, no significant difference for ages 18-49, and higher risk for age 12-17.

Confounding by contraindication. Hoertel et al. find that over 50% of patients that died had a contraindication for the use of Paxlovid Hoertel. Retrospective studies that do not exclude contraindicated patients may significantly overestimate efficacy.

Black box warning. The FDA notes that "severe, life-threatening, and/or fatal adverse reactions due to drug interactions have been reported in patients treated with paxlovid" FDA.

1. FDA, Fact sheet for healthcare providers: emergency use authorization for paxlovid, www.fda.gov/media/155050/download.fda.gov.

2. Hoertel et al., Prevalence of Contraindications to Nirmatrelvir-Ritonavir Among Hospitalized Patients With COVID-19 at Risk for Progression to Severe Disease, JAMA Network Open, doi:10.1001/jamanetworkopen.2022.42140.jamanetwork.com, doi.org.

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risk of PASC, 8.0% lower, RR 0.92, p < 0.001, 50+, 1+ PCC, propensity score matching.

risk of PASC, 7.0% higher, RR 1.07, p = 0.005, 12-17, 1+ PCC, propensity score matching.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

Dalton et al., 11 Oct 2023, retrospective, USA, preprint, 2 authors.

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