Risk of [LC] and Oral Antivirals in Adults Aged Over 60 years: A Nationwide Retrospective Cohort Study, 2025, Jooa et al

Risk of Post-Acute Sequelae of COVID-19 and Oral Antivirals in Adults Aged Over 60 years: A Nationwide Retrospective Cohort Study

Hyejin Jooa, Eunji Kimc, Kyungmin Huhd, Gi Hwan Baea, Hyungmin Leee, Jungyeon Kime, Dong-Hwi Kime, Min-Gyu Yooe, Il Uk Joi, Poong Hoon Leei, Geun Woo Leei, Hee Sun Jungi, Jaehun Junga

Highlights

• Nirmatrelvir/ritonavir significantly reduced the risk of cardiovascular diseases.
• They lowered the risk of hospitalization due to respiratory and renal diseases.
• Molnupiravir reduced ischemic stroke and other cerebrovascular disease risk.
• Respiratory conditions—COPD, asthma—decreased by approximately 13–14%.
• Oral antivirals may mitigate the indirect SARS-CoV-2 infection effects.

Objectives
To investigate the association between oral antiviral administration and post-acute sequelae of COVID-19 (PASC) risk in Korea.

Methods
This retrospective cohort study used data from the Korea Disease Control and Prevention Agency and the Health Insurance Review and Assessment Service. We analyzed data from COVID-19 patients aged > 60 years from January to December 2022. The primary outcome was the occurrence of 27 PASCs within 30–120 days after COVID-19 diagnosis. The hazard ratio was calculated using the Cox proportional hazards model.

Results
Nirmatrelvir/ritonavir significantly reduced the risk of cardiovascular diseases, including heart failure and cardiomyopathies (aHR, 0.86), cardiac dysrhythmias (aHR, 0.83), and ischemic stroke (aHR, 0.88). Moreover, it also lowered the risk of hospitalization due to respiratory diseases including chronic obstructive pulmonary disease (aHR, 0.92) and decreased renal disorders including dialysis needs (aHR, 0.57) and acute renal failure (aHR, 0.85). Molnupiravir reduced the risk of ischemic stroke (aHR, 0.84) and other cerebrovascular diseases (aHR, 0.84). Respiratory conditions decreased by approximately 13–14% (aHR, 0.87 and 0.86, respectively).

Conclusions
Nirmatrelvir/ritonavir and molnupiravir administration in ambulatory patients were associated with decreased PASC risk; thus, oral antivirals may mitigate the indirect SARS-CoV-2 infection effects.

Link | PDF (International Journal of Infectious Diseases) [Open Access]

 

I believe their conclusion is slightly misleading. It should be ‘decreased the risk of certain disease entities in people >60 years following a SARS-CoV-2 infection’. They did not look at PASC as a whole, and it was a limited demographic group.

Based on the comprehensive literature review, we listed potential PASCs.[21–23] We selected disease entities, as opposed to individual symptoms, that could be reliably identified within the healthcare claims database. The potential PASCs include 27 distinct diseases across eight domains including gastrointestinal, hepatic, cardiovascular, respiratory, endocrine, renal, venous embolism, and neurologic domains.[21] Each outcome was defined as the occurrence of a new event for the first time in life during the follow-up period. These events were identified through hospital admission, emergency room (ER) visit, or specific procedures or treatments. Detailed operational definitions for these outcomes are described in eTable 2.