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0 0.5 1 1.5 2+ PASC -14% Improvement Relative Risk Paxlovid  Durstenfeld et al.  EARLY TREATMENT  LONG COVID Does paxlovid reduce the risk of Long COVID (PASC)? Retrospective 4,684 patients in the USA No significant difference in PASC Durstenfeld et al., J. Medical Virology, Jan 2024 Favors paxlovid Favors control

Association of nirmatrelvir for acute SARS‐CoV‐2 infection with subsequent Long COVID symptoms in an observational cohort study

Durstenfeld et al., Journal of Medical Virology, doi:10.1002/jmv.29333
Jan 2024  
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Retrospective 4,684 COVID+ patients mostly in the USA, 988 treated with paxlovid, showing higher risk of long COVID with treatment, without statistical significance.
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.
risk of PASC, 14.3% higher, RR 1.14, p = 0.40, treatment 57 of 353 (16.1%), control 176 of 1,258 (14.0%), odds ratio converted to relative risk, propensity score weighting, model 4.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Durstenfeld et al., 4 Jan 2024, retrospective, USA, peer-reviewed, 13 authors. Contact:,
This PaperPaxlovidAll
Association of nirmatrelvir for acute SARS‐CoV‐2 infection with subsequent Long COVID symptoms in an observational cohort study
Matthew S Durstenfeld, Michael J Peluso, Feng Lin, Noah D Peyser, Carmen Isasi, Thomas W Carton, Timothy J Henrich, Steven G Deeks, Jeffrey E Olgin, Mark J Pletcher, Alexis L Beatty, Gregory M Marcus, Priscilla Y Hsue
Journal of Medical Virology, doi:10.1002/jmv.29333
Oral nirmatrelvir/ritonavir is approved as treatment for acute COVID-19, but the effect of treatment during acute infection on risk of Long COVID is unknown. We hypothesized that nirmatrelvir treatment during acute SARS-CoV-2 infection reduces risk of developing Long COVID and rebound after treatment is associated with Long COVID. We conducted an observational cohort study within the Covid Citizen Science (CCS) study, an online cohort study with over 100 000 participants. We included vaccinated, nonhospitalized, nonpregnant individuals who reported their first SARS-CoV-2 positive test March-August 2022. Oral nirmatrelvir/ritonavir treatment was ascertained during acute SARS-CoV-2 infection. Patient-reported Long COVID symptoms, symptom rebound and test-positivity rebound were asked on subsequent surveys at least 3 months after SARS-CoV-2 infection. A total of 4684 individuals met the eligibility criteria, of whom 988 (21.1%) were treated and 3696 (78.9%) were untreated; 353/988 (35.7%) treated and 1258/3696 (34.0%) untreated responded to the Long COVID survey (n = 1611). Among 1611 participants, median
The other authors report no conflicts of interest. DATA AVAILABILITY STATEMENT The data that support the findings of this study are available from the corresponding author upon reasonable request. Data are available by application to the COVID Citizen Science leadership committee. Data may be requested by emailing SUPPORTING INFORMATION Additional supporting information can be found online in the Supporting Information section at the end of this article.
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