Paxlovid shows organ-specific and age-specific impacts on risk of developing post-acute sequelae of COVID-19
BACKGROUND
The impact of antiviral therapies, including Paxlovid, on post-acute sequelae of COVID-19 (PASC) remains inconclusive.
METHODS
We analyzed data from 19,413 patients (age > 18) from a validated PASC research cohort in New England who experienced at least one COVID-19 infection episode between January 1, 2022, and June 7, 2022, totaling 22,094 episodes. Multivariable logistic regression with inverse probability weights was used to infer the causal effects of Paxlovid treatment during acute infection and the risk of PASC overall (primary outcome), stratified by age group and organ system.
RESULTS
Across all age groups, Paxlovid shows no statistically significant effect in lowering overall PASC risk. Stratification by organ system reveals a 37% reduction in gastrointestinal PASC (OR: 0.63; 95% CI: [0.468, 0.850]; p < 0.05) but a 97.4% increase in the risk of eye and ear-related PASC (OR: 1.974; 95% CI: [1.048, 3.718]; p < 0.05). Among patients aged 65 to 75 years who were not hospitalized, Paxlovid is associated with a 16.8% reduction in PASC risk (OR: 0.832; 95% CI: [0.7, 0.989]; p < 0.05). No statistically significant effects is observed for other organ-specific outcomes.
CONCLUSIONS
Paxlovid demonstrates organ-specific effects on the risk of PASC, with a reduction in gastrointestinal symptoms and an increased risk of eye and ear-related symptoms. In older, non-hospitalized patients, Paxlovid modestly reduces overall PASC risk. These findings highlight the complexity of antiviral therapys long-term impact and underscore the need for further research to clarify the mechanisms underlying these outcomes.
PLAIN LANGUAGE SUMMARY
Long COVID refers to health problems that continue or appear weeks or months after a person recovers from COVID-19. In this study, we investigated whether taking the antiviral medication, Paxlovid, can reduce the risk of developing Long COVID. We analyzed medical records from over 19,000 adults treated at hospitals across New England. Overall, Paxlovid did not lower the total risk of developing Long COVID. However, it was linked with fewer digestive symptoms and showed modest benefit in older, non-hospitalized adults. At the same time, it was associated with a higher chance of eye or ear-related symptoms. These findings suggest that Paxlovid may help in specific situations, but more research is needed to understand who benefits most and why.
Web | DOI | PDF | Nature Communications Medicine | Open Access
Azhir, Alaleh; Cheng, Jingya; Tian, Jiazi; Murphy, Shawn N; Estiri, Hossein
BACKGROUND
The impact of antiviral therapies, including Paxlovid, on post-acute sequelae of COVID-19 (PASC) remains inconclusive.
METHODS
We analyzed data from 19,413 patients (age > 18) from a validated PASC research cohort in New England who experienced at least one COVID-19 infection episode between January 1, 2022, and June 7, 2022, totaling 22,094 episodes. Multivariable logistic regression with inverse probability weights was used to infer the causal effects of Paxlovid treatment during acute infection and the risk of PASC overall (primary outcome), stratified by age group and organ system.
RESULTS
Across all age groups, Paxlovid shows no statistically significant effect in lowering overall PASC risk. Stratification by organ system reveals a 37% reduction in gastrointestinal PASC (OR: 0.63; 95% CI: [0.468, 0.850]; p < 0.05) but a 97.4% increase in the risk of eye and ear-related PASC (OR: 1.974; 95% CI: [1.048, 3.718]; p < 0.05). Among patients aged 65 to 75 years who were not hospitalized, Paxlovid is associated with a 16.8% reduction in PASC risk (OR: 0.832; 95% CI: [0.7, 0.989]; p < 0.05). No statistically significant effects is observed for other organ-specific outcomes.
CONCLUSIONS
Paxlovid demonstrates organ-specific effects on the risk of PASC, with a reduction in gastrointestinal symptoms and an increased risk of eye and ear-related symptoms. In older, non-hospitalized patients, Paxlovid modestly reduces overall PASC risk. These findings highlight the complexity of antiviral therapys long-term impact and underscore the need for further research to clarify the mechanisms underlying these outcomes.
PLAIN LANGUAGE SUMMARY
Long COVID refers to health problems that continue or appear weeks or months after a person recovers from COVID-19. In this study, we investigated whether taking the antiviral medication, Paxlovid, can reduce the risk of developing Long COVID. We analyzed medical records from over 19,000 adults treated at hospitals across New England. Overall, Paxlovid did not lower the total risk of developing Long COVID. However, it was linked with fewer digestive symptoms and showed modest benefit in older, non-hospitalized adults. At the same time, it was associated with a higher chance of eye or ear-related symptoms. These findings suggest that Paxlovid may help in specific situations, but more research is needed to understand who benefits most and why.
Web | DOI | PDF | Nature Communications Medicine | Open Access
