In a recent publication in the Journal of the American Medical Association Internal Medicine, researchers from the Washington University School of Medicine in St. Louis and the Veterans Affairs St. Louis Health Care system conducted a cohort study to explore whether treatment with nirmatrelvir in the acute phase of COVID-19 is correlated with decreased risk of post-COVID-19 condition (PCC).
Utilizing healthcare databases from the Department of Veterans Affairs (VA) between January 3, 2022, and December 31, 2022, researchers screened databases to identify patients who had received a positive SARS-CoV-2 test between that time frame and met the following criteria: had at least one risk factor for progression to a severe illness, had survived the first 30 days after diagnosis, and were not hospitalized on the day of the positive test.
The cohort included 281,793 participants comprised of 35,717 patients who were prescribed oral nirmatrelvir within 5 days after a positive test (nirmatrelvir group) and 246,076 patients who did not receive outpatient treatment for COVID-19 within 30 days after a positive test (control group).
The primary study outcome was an estimation of nirmatrelvir therapy-related hospitalization, death, or PCC after the acute phase of illness, and the researchers employed an inverse probability–weighted survival model to obtain these estimates.
The results revealed that compared with the control group, nirmatrelvir was associated with reduced risk of PCC, including reduced risk of 10 of 13 postacute sequelae in various organ systems, as well as reduced risk of postacute death and postacute hospitalization. Additionally, nirmatrelvir was associated with reduced risk of PCC in unvaccinated, vaccinated, and boosted individuals and in individuals with primary SARS-CoV-2 infection and reinfection.
The results also revealed that the use of nirmatrelvir decreased the risk of PCC by 26% over a 6-month period and, comparably, during the same time frame, decreased the risk of postacute mortality by 47% and the risk of postacute hospitalization by 24%.
Based on their findings, the authors wrote, “The totality of evidence suggests that improving the uptake and use of nirmatrelvir in the acute phase as a means of not only preventing progression to severe acute disease but also reducing the risk of postacute adverse health outcomes may be beneficial.”
The authors concluded, “This cohort study found that in people with SARS-CoV-2 infection who had at least one risk factor for progression to severe disease, treatment with nirmatrelvir within five days of a positive SARS-CoV-2 test was associated with a reduced risk of PCC across the risk spectrum in this cohort and regardless of vaccination status and history of prior infection. These findings suggest that the salutary benefit of nirmatrelvir may extend to the post–acute phase of COVID-19.”
In a news story, senior author Ziyad Al-Aly, MD, a Washington University clinical epidemiologist who has extensively studied the long-term effects of COVID-19 infection, stated, “Our study suggests Paxlovid is an effective weapon against COVID-19’s potential for debilitating and life-threatening effects on the body.”
Dr. Al-Aly also noted, “All hypotheses of long COVID point to SARS-CoV-2 as the initiating agent. Our research reinforces such theories. It stands to reason that an antiviral drug—one that suppresses viral replication—may reduce the risk of long COVID.
“This gives me hope that antivirals may hold the key to preventing long COVID-19,” Dr. Al-Aly added. “More research is needed to determine whether antiviral drugs other than Paxlovid are also effective at preventing long COVID.”
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