ABSTRACT
Among adults at risk for severe coronavirus disease 2019 (COVID-19), the lowest hospitalization rate was among those who received nirmatrelvir-ritonavir after 3 or more messenger RNA vaccine doses (adjusted hazard ratio, 0.22; 95% confidence interval, .19-.24). Eligible adults, including those previously vaccinated, should be considered for COVID-19 antiviral treatment.
Subject(s)
Antiviral Agents , COVID-19 Vaccines , COVID-19 , Hospitalization , Ritonavir , SARS-CoV-2 , Humans , Ritonavir/therapeutic use , Ritonavir/administration & dosage , Hospitalization/statistics & numerical data , Male , Middle Aged , Female , COVID-19/prevention & control , COVID-19/epidemiology , Adult , SARS-CoV-2/immunology , Antiviral Agents/therapeutic use , Antiviral Agents/administration & dosage , COVID-19 Vaccines/administration & dosage , Aged , Vaccination/statistics & numerical data , Leucine/analogs & derivatives , Leucine/therapeutic use , COVID-19 Drug Treatment , Lactams , Nitriles , ProlineSubject(s)
COVID-19 , Adult , Humans , United States/epidemiology , COVID-19/epidemiology , HospitalizationABSTRACT
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) 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] = 0.49), among those who had received ≥3 mRNA COVID-19 vaccines (aHR = 0.50), and across age groups (18-49 years: aHR = 0.59; 50-64 years: aHR = 0.40; and ≥65 years: aHR = 0.53). Paxlovid should be prescribed to eligible adults to reduce the risk of COVID-19-associated hospitalization.