Among younger adults, Paxlovid shows benefits for some but not others
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Key takeaways:
- Paxlovid reduced emergency department visits, hospitalization and death from COVID-19 among younger adults.
- The associated benefit was increased for patients with comorbidities.
Paxlovid lowers the risk for severe COVID-19 among younger vaccinated adults with at least one serious comorbidity, researchers found, although their study did not see the same benefit for patients without medical comorbidities.
“We wanted a window into whether Paxlovid might help younger, vaccinated people and if so, who?” Jeremy S. Faust MD, MS, an emergency medicine physician at Brigham and Women's Hospital in Boston and Harvard Medical School, told Healio.
“Pfizer had cancelled its trial (EPIC-SR) due to futility, but it was clear that a lot of younger people were getting Paxlovid prescriptions anyway, and not all of them had genuinely high risks. In particular, a lot of young people with asthma believe they are at higher risk of severe COVID, when in reality the data have never been conclusive on that,” Faust said. “I have mild asthma. I've never had COVID. I was curious whether I might benefit, if and when I get COVID.”
Faust and colleagues assessed whether Paxlovid benefited younger adults by generating two propensity-matched cohorts of 2,547 patients from an 86,119-person cohort of nonhospitalized vaccinated patients aged younger than 50 years with COVID-19 from a large database. The study population was split into two arms: patients who received Paxlovid and patients who did not. The primary outcome was a composite of all-cause emergency department visits, hospitalization and mortality.
Taking Paxlovid was associated with a more than 30% reduction in the primary outcome (4.9% vs. 7.03%; OR = 0.683; 95% CI, 0.54-0.864). There were significantly fewer all-cause hospitalizations in the group treated with Paxlovid (15 vs. 43; OR = 0.34; 95% CI, 0.191-0.623).
Subgroup analyses showed significant associations for the primary outcome among patients prescribed Paxlovid with cancer (OR = 0.692; 95% CI, 0.472-0.987), cardiovascular disease (OR = 0.629; 95% CI, 0.461-0.858) and cancer and cardiovascular disease (OR = 0.432; 95% CI, 0.275-0.677) but not among patients prescribed Paxlovid with only chronic lower respiratory tract disorders — such as asthma and chronic obstructive pulmonary disease — or among patients without any serious existing comorbidities (OR = 0.927; 95% CI, 0.431-1.991).
Based on these results, the authors said that identifying high-risk patients should be a priority and clinicians should avoid overprescribing Paxlovid.
“We believe Paxlovid is both overprescribed and underprescribed. There are probably young and relatively healthy people who are taking it who don't need it,” Faust said. “Meanwhile, there are likely those with higher risks and those with less access to care who are not getting it. Equity is always a concern.”
“The worried wealthy should not get this or any drug more than truly at-risk underserved populations,” he said.
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Faust JS, et al. Clin Infect Dis. 2023;doi:10.1093/cid/ciad400.
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