Sorry, but there is still plenty of Covid going around. One would always like to avail themselves of anything that will help speed recovery. Will you get better faster if you take Paxlovid for Covid 19? Maybe not. Here is a summary of an article from Journal Watch with an interesting commentary. The original article was in The New England Journal of Medicine.
April 9, 2024
Should Patients with COVID-19 Who Are at Standard Risk Take Nirmatrelvir/Ritonavir?
Molly S. Brett, MD, reviewing
Patients at average risk for progression to severe disease did not benefit.
U.S. National Institutes of Health guidelines currently recommend nirmatrelvir/ritonavir (Paxlovid) as first-line therapy for outpatients with COVID-19 who are at high risk for progressing to severe disease. This recommendation stems from the initial randomized trial of Paxlovid, which showed that the drug lowered risk for hospitalization and death among high-risk, unvaccinated adults (NEJM JW Gen Med Apr 15 2022 and N Engl J Med 2022; 386:1397). In subsequent observational trials, benefits have varied, depending on the patient population included.
Now, in a manufacturer-sponsored trial, researchers examined the effectiveness of Paxlovid among standard-risk patients. About 1300 adults (median age, 42) with symptomatic COVID-19 received 5-day courses of Paxlovid or placebo. Participants were fully vaccinated with at least one risk factor for severe disease (e.g., smoking, hypertension, obesity), or they had no risk factors and were unvaccinated (i.e., never vaccinated or no vaccine within the past 1 year). Fewer than 2% of patients had heart or lung disease, and only 5% were 65 or older.
The primary outcome — time to sustained alleviation of symptoms — did not differ between the Paxlovid and placebo groups. A secondary outcome (COVID-related hospitalization or death from any cause) occurred in 5 Paxlovid recipients and in 10 placebo recipients; this difference was not significant.
Dr. Brett is an Assistant Professor of Medicine at the University of Colorado.
Dr. Rajesh T. Gandhi is a member of the NEJM Journal Watch Infectious Diseases board but was not involved in selecting or summarizing this article.
CITATIONS
Hammond J et al. Nirmatrelvir for vaccinated or unvaccinated adult outpatients with Covid-19. N Engl J Med 2024 Apr 4; 390:1186. (https://doi.org/10.1056/NEJMoa2309003)
Gandhi RT and Hirsch M. Treating acute Covid-19 — Final chapters still unwritten. N Engl J Med 2024 Apr 4; 390:1234. (https://doi.org/10.1056/NEJMe2402224)
COMMENT
My primary care patients frequently ask about treatment for COVID-19, and these results will help me guide them. Unvaccinated healthy adults and fully vaccinated patients with certain comorbidities do not appear to benefit from Paxlovid. An important caveat: This study’s participants were relatively young and healthy, without severe comorbidities. I will continue to suggest Paxlovid to patients who are older, immunosuppressed, or have serious chronic illnesses — particularly those who are unvaccinated.