In young adults, Paxlovid shows benefit for some but not others

Key points to remember:

• Paxlovid has reduced emergency room visits, hospitalizations and deaths from COVID-19 among young adults.
• The associated benefit was increased for patients with comorbidities.

Paxlovid reduces the risk of severe COVID-19 in vaccinated young adults with at least one severe comorbidity, the researchers found, although their study did not see the same benefit for patients without medical comorbidities.

“We wanted a window into whether Paxlovid could help younger, vaccinated people and if so, who? » Jeremy S. Faust MD, MS, an emergency physician at Brigham and Women’s Hospital in Boston and Harvard Medical School, Healio told.

“Pfizer had canceled its (EPIC-SR) trial due to its futility, but it was clear that a lot of young people were getting Paxlovid prescriptions anyway, and not all of them were really at high risk. In particular, a lot of young asthmatics think they are at higher risk for severe COVID, when in reality the data has never been conclusive on this,” Faust said. “I have mild asthma. had COVID.I was curious if I could benefit from it, if and when I get COVID.

Faust and colleagues assessed whether Paxlovid benefited young adults by generating two propensity-matched cohorts of 2,547 patients from a cohort of 86,119 non-hospitalized vaccinated patients younger than 50 with COVID-19 from a large database. The study population was divided into two arms: patients who received Paxlovid and patients who did not. The main result was A composite of all-cause emergency room visits, hospitalization and mortality.

Taking Paxlovid was associated with a greater than 30% reduction in primary outcome (4.9% versus 7.03%; OR=0.683; 95% CI, 0.54-0.864). There were significantly fewer all-cause hospitalizations in the Paxlovid-treated group (15 versus 43; OR = 0.34; 95% CI, 0.191-0.623).

Subgroup analyzes showed significant associations for the primary outcome in patients prescribed Paxlovid with cancer (OR=0.692; 95% CI, 0.472-0.987), cardiovascular disease (OR=0.629; CI at 95%, 0.461-0.858) and cancer and cardiovascular diseases (OR=0.432; 95% CI, 0.275-0.677) but not in patients prescribed Paxlovid with only chronic lower airway disorders – such as asthma and chronic obstructive pulmonary disease – or in patients without any existing serious comorbidity (OR = 0.927; 95% CI, 0.431-1.991).

Based on these findings, the authors said identifying high-risk patients should be a priority and clinicians should avoid prescribing too much Paxlovid.

“We believe Paxlovid is both over-prescribed and under-prescribed. There are probably young, relatively healthy people taking it who don’t need it,” Faust said. “In the meantime, there are probably those who are at higher risk and those who have less access to care who are not receiving it. Equity is always a concern.

“Wealthy people who are worried shouldn’t get this drug or any other drug any more than really at-risk underserved populations,” he said.

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