Report from the CDC: MMWR Paxlovid associated with decreased hospitalization rate among adults with COVID-19 -United States, April-September 2022
MD Melisa M Shah, Brendan Joyce, MBBS Ian D Plumb, MS Sam Sahakian, PhD Leora R Feldstein, Eric Barkley, MSP Mason Paccione, PhD Joseph Deckert, MPH Danessa Sandmann, MD Jacqueline L Gerhart, MD Melissa Briggs Hagen
doi:10.1016/j.ajt.2022.12.
What is already known about this topic? Nirmatrelvir-ritonavir (Paxlovid) is an outpatient antiviral medication recommended for adults with mild-to-moderate COVID-19 who have elevated risk of severe illness. What is added by this report? Among U.S. adults diagnosed with COVID-19, including those with previous infection or vaccination, persons who were prescribed Paxlovid within 5 days of diagnosis had a 51% lower hospitalization rate within 30 days after diagnosis than those who were not prescribed Paxlovid.
What are the implications for public health practice? Paxlovid should be offered to eligible adults irrespective of vaccination status, especially in groups with the highest risk for severe COVID-19 outcomes, such as older adults and those with multiple underlying health conditions. Nirmatrelvir-ritonavir (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. However, real-world evidence on the benefit of Paxlovid, according to vaccination status, age group, and underlying health conditions, is limited. To examine the benefit of Paxlovid in adults aged !18 years in the United States, a large electronic health record (EHR) data set (Cosmos y ) was analyzed to assess the association between receiving a prescription for Paxlovid and hospitalization with a COVID-19 diagnosis in the ensuing 30 days. A Cox proportional hazards model was used to estimate this association, adjusted for demographic characteristics, geographic location, vaccination, previous infection, and number of underlying health conditions. Among 699,848 adults aged !18 years eligible for Paxlovid during April-August 2022, 28.4% received a Paxlovid prescription within 5 days of COVID-19 diagnosis. Being prescribed Paxlovid was associated with a lower hospitalization rate among the overall study population (adjusted hazard ratio [aHR] ¼ 0.49), among those who had received !3 mRNA COVID-19 vaccines (aHR ¼ 0.50), and across age groups (18-49 years: aHR ¼ 0.59; 50-64 years: aHR ¼ 0.40; and !65 years: aHR ¼ 0.53). Paxlovid should be prescribed to eligible adults to reduce the risk of COVID-19-associated hospitalization. Paxlovid is an oral antiviral medication that received Emergency Use Authorization by the Food and Drug Administration on December 22, 2021 (1), for use in patients with mild-to-moderate COVID-19 at high risk for progression to severe illness. Eligibility for Paxlovid includes 1) receipt of a positive SARS-CoV-2 test result (including home antigen test), 2) symptoms consistent with mild-to-moderate COVID-19, 3) symptom onset within the past 5 days, 4) age !18 years (or age !12 years and weight !40 kg), 5) one or more risk factors for progression to severe COVID-19, 6) no known or suspected severe renal or hepatic impairment, 7) no history of clinically significant reactions (e.g., toxic epidermal necrolysis or Stevens-Johnson syndrome) to the active ingredients..
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