The website will be down at times for maintenance from 8:00 a.m. CT Saturday, March 2 through 10:00 a.m. CT Sunday, March 3.

brand logo

Am Fam Physician. 2023;107(3):316

Clinical Question

Does nirmatrelvir/ritonavir (Paxlovid) improve outcomes in a largely vaccinated population of patients with COVID-19?

Bottom Line

Paxlovid reduces hospitalization and mortality in older, high-risk patients with COVID-19, but data in younger vaccinated patients are inconsistent. More studies are needed, particularly in patients 50 to 64 years of age. (Level of Evidence = 2b)

Synopsis

The primary study used to approve Paxlovid for use in out-patients with COVID-19 included only high-risk unvaccinated patients. The most recent study from a large health system in Israel identified adults 40 years and older who were eligible to receive the drug during the Omicron surge. It compared patients who received Paxlovid within five days of a confirmed diagnosis of COVID-19 with patients who did not. Overall, 78% of included patients had previous immunity by vaccination, prior infection, or both. The analysis was adjusted for comorbidities, demographics, ethnicity, religious affiliation, and socioeconomic status. Approximately 80% of participants were considered fully vaccinated. Data were stratified by age, and benefit was only seen in people 65 years and older. The rate of hospitalization (14.7 vs. 58.9 cases per 100,000 person-days; adjusted hazard ratio [HR] = 0.27; 95% CI, 0.15 to 0.49) and the risk of death (HR = 0.21; 95% CI, 0.05 to 0.82) were lower in this group. There was no difference in either outcome in patients 40 to 64 years of age. Past research has shown a higher overall risk for patients older than 50 years, but results for patients 50 to 64 years of age were not reported in this study. A second study from Hong Kong compared outcomes in outpatients given Paxlovid with those who were not treated. This study found lower rates of mortality (HR = 0.25; 95% CI, 0.13 to 0.47) and hospitalization (HR = 0.69; 95% CI, 0.60 to 0.79) in patients given Paxlovid. The study found no difference in benefit by age, although only approximately 20% of the patients in the study were younger than 65 years, and only 35% were fully vaccinated.

Already a member/subscriber?  Log In

Subscribe

From $165
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available
Subscribe

Issue Access

$59.95
  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see https://www.essentialevidenceplus.com/Home/Loe?show=Sort.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Natasha J. Pyzocha, DO, contributing editor.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

Continue Reading

More in AFP

More in Pubmed

Copyright © 2023 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.