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0 0.5 1 1.5 2+ PASC, 30-180, broad 20% Improvement Relative Risk PASC, 30-180, narrow 25% PASC, 90-180, broad 29% PASC, 90-180, narrow 26% Patel et al. Paxlovid for COVID-19 EARLY TREATMENT Is early treatment with paxlovid beneficial for COVID-19? PSM retrospective 2,008 patients in the USA (Dec 2021 - Apr 2022) Lower PASC with paxlovid (p=0.014) Patel et al., medRxiv, doi:10.1101/2023.04.05.23288196 Favors paxlovid Favors control

Incidence of Symptoms Associated with Post-Acute Sequelae of SARS-CoV-2 infection in Non-Hospitalized Vaccinated Patients Receiving Nirmatrelvir-Ritonavir

Patel et al., medRxiv, doi:10.1101/2023.04.05.23288196 (Preprint)
Patel et al., Incidence of Symptoms Associated with Post-Acute Sequelae of SARS-CoV-2 infection in Non-Hospitalized.., medRxiv, doi:10.1101/2023.04.05.23288196 (Preprint)
Apr 2023   Source   PDF  
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TriNetX retrospective 1,004 paxlovid patients and matched controls, showing lower risk of PASC with treatment.
Confounding by treatment propensity. This study analyzes a population where only a fraction of eligible patients received the treatment. Patients receiving treatment may be more likely to follow other recommendations, more likely to receive additional care, and more likely to receive adjuvant treatments that are not tracked in the data (e.g., nasal/oral hygiene [, (B)], vitamin D [ (C)], etc.) — either because the physician recommending paxlovid also recommended them, or because the patient seeking out paxlovid is more likely to be familiar with the efficacy of additional treatments. Therefore, these kind of studies may overestimate the efficacy of treatments.
Confounding by contraindication. [Hoertel] find that over 50% of patients that died had a contraindication for the use of Paxlovid. Retrospective studies that do not exclude contraindicated patients may significantly overestimate efficacy.
risk of PASC, 20.0% lower, RR 0.80, p = 0.01, treatment 1,004, control 1,004, broadly defined, 30-180 days, propensity score matching.
risk of PASC, 25.0% lower, RR 0.75, p = 0.01, treatment 1,004, control 1,004, narrowly defined, 30-180 days, propensity score matching.
risk of PASC, 29.0% lower, RR 0.71, p = 0.01, treatment 1,004, control 1,004, broadly defined, 90-180 days, propensity score matching.
risk of PASC, 26.0% lower, RR 0.74, p = 0.01, treatment 1,004, control 1,004, narrowly defined, 90-180 days, propensity score matching.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Patel et al., 6 Apr 2023, retrospective, USA, preprint, mean age 57.2, 17 authors, study period 1 December, 2021 - 17 April, 2022.
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This PaperPaxlovidAll
Incidence of Symptoms Associated with Post-Acute Sequelae of SARS-CoV-2 infection in Non-Hospitalized Vaccinated Patients Receiving Nirmatrelvir-Ritonavir 
MD Rushin Patel, MD Sourbha S Dani, MD Sumanth Khadke, MD Javaria Ahmad, MD Jui Shah, MD MPH Neev Mehta, MD Kenneth Wener, MD Daniel P Mcquillen, MD MPH George Abraham, MD Jeremy Faust, MD Jason Maley, MD Smita Patel, MD Janet Mullington, MD Robert M Wachter, MD Anne Mosenthal, MD Paul E Sax, MD Sarju Ganatra
Assessment of Nirmatrelvir plus ritonavir (NMV-r) in preventing post-acute sequelae of SARS-CoV-2 infection (PASC), based on broad and narrow definitions in non-hospitalized, vaccinated patients between 30-180 days and 90-180 days.
Al-Aly, Bowe, Xie, Long COVID after breakthrough SARS-CoV-2 infection, Nat Med
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Bernal, Da Silva, Musungaie, Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients, N Engl J Med
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Elfein, Number of coronavirus (COVID-19) cases, recoveries, and deaths worldwide
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Gottlieb, Vaca, Paredes, Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients, N Engl J Med
Hammond, Leister-Tebbe, Gardner, Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19, N Engl J Med
Organization, Post COVID-19 condition (Long COVID
Rando, Bennett, Byrd, Challenges in defining Long COVID: Striking differences across literature, Electronic Health Records, and patient-reported information, medRxiv
Recover, Explore Research
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Please send us corrections, updates, or comments. Vaccines and treatments are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment, vaccine, or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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