Preprint Real-World Effectiveness of Nirmatrelvir in Protecting Long COVID for Outpatient Adult Patients – [...] RECOVER, 2024, Wang et al.

Real-World Effectiveness of Nirmatrelvir in Protecting Long COVID for Outpatient Adult Patients – A Large-Scale Observational Cohort Study from the RECOVER Initiative
Fei Wang; Chengxi Zang; Haoyang Li; Dhru Khullar; Yongkang Zhang; Stephenson Strobel; Yong Chen; Marc Sala; Payal Patel; Alejandro Comellas; Andrew Wylam; Mark Weiner; Christopher Forrest; Thomas Carton; Rainu Kaushal

Paxlovid has been approved for use in patients who are at high risk for severe acute COVID-19 illness. Evidence regarding whether Paxlovid protects against Post-Acute Sequelae of SARS-CoV-2 infection (PASC), or Long COVID, is mixed in high-risk patients and lacking in low-risk patients.

With a target trial emulation framework, we evaluated the association of Paxlovid treatment within 5 days of SARS-CoV-2 infection with incident Long COVID and hospitalization or death from any cause in the post-acute period (30–180 days after infection) using electronic health records from the Patient-Centered Clinical Research Networks (PCORnet) RECOVER repository. The study population included 497,499 SARS-CoV-2 positive patients between March 1, 2022, to February 1, 2023, and among which 165,256 were treated with Paxlovid within 5 days since infection and 307,922 were not treated with Paxlovid or other COVID-19 treatments.

Compared with the non-treated group, Paxlovid treatment was associated with reduced risk of Long COVID with a Hazard Ratio (HR) of 0.88 (95% CI, 0.87 to 0.89) and absolute risk reduction of 2.99 events per 100 persons (95% CI, 2.65 to 3.32). Paxlovid treatment was associated with reduced risk of all-cause death (HR, 0.53, 95% CI 0.46 to 0.60; risk reduction 0.23 events per 100 persons, 95% CI 0.19 to 0.28) and hospitalization (HR, 0.70, 95% CI 0.68 to 0.73; risk reduction 2.37 events per 100 persons, 95% CI 2.19 to 2.56) in the post-acute phase. For those without documented risk factors, the associations (HR, 1.03, 95% CI 0.95 to 1.11; risk increase 0.80 events per 100 persons, 95% CI -0.84 to 2.45) were inconclusive.

Overall, high-risk, nonhospitalized adult patients with COVID-19 who were treated with Paxlovid within 5 days of SARS-CoV-2 infection had a lower risk of Long COVID and all-cause hospitalization or death in the post-acute period. However, Long COVID risk reduction with Paxlovid was not observed in low-risk patients.

Link | PDF (Preprint: Research Square) [Open Access]

 

Should 'Protecting Long COVID' be 'Preventing Long COVID'?

There also needs to be clarification that Nirmatrelvir is the proper name for Paxlovid.

 

That would seem like the better title to me, but perhaps if one looks at whether it reduces severity and duration of LC, which is actually what one wants to do, preventing is also not an ideal title.

Accurate would be Paxlovid=Nirmatrelvir+Ritonavir. Sometimes Paxlovid and Nirmatrelvir are used interchangeably though. I don't think there needs to be any clarification since it's abudantly clear in the paper (or by googling the names).

The piece seems to show what most people have been expecting, in that Paxlovid is good in the acute phase for high-risk patients, reduces PICS etc but does nothing to prevent Long-Covid in its syndromic nature which stems mostly from mild infection.