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A Real-Life Analysis of Paxlovid – Does It Work?

July 4, 2022

Written by Jonathan Brewer

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In the omicron era, nirmatrelvir/ritonavir (Paxlovid) is highly effective in reducing the risk of severe COVID-19 and mortality.

Why does this matter?
We have long been searching for an oral medication to treat our mild-moderate COVID-19 patients that may be at high risk for progressing to severe COVID-19 and death. While adequate vaccination remains the most effective prevention, clinicians should be aware of this treatment option in high-risk patients that we may discharge home.

Paxlovid deserves some praise
This was a retrospective, population-based, real-world study in Israel to evaluate the effectiveness of Paxlovid in a non-controlled setting between January-February 2022. All high-risk adults (see EPIC-HR trial for risk factors) aged ≥ 18 years with their first ever positive test for SARS-CoV-2 and without contraindications for Paxlovid (see prescribing how-to) were enrolled.

Out of 180,351 eligible adults, 4,737 (2.6%) were treated with Paxlovid. 135,482 (75.1%) had adequate COVID-19 vaccination status. A Cox hazard regression was utilized to estimate the 28-day hazard ratio (HR) for severe COVID-19 or mortality, with Paxlovid examined as the time-dependent variable. The study demonstrated that Paxlovid and adequate vaccination status were each associated with significant decrease in both progression to severe infection and/or mortality with adjusted HR 0.54 (95%CI 0.39-0.75) and 0.20 (95%CI 0.17-0.22), respectively.

While this was a different population and mainly associated with the omicron variant due to the timing of the study (EPIC-HR was conducted while Delta was dominant and only included unvaccinated patients), Paxlovid remains a good option for our high-risk patients moving forward.

Effectiveness of Paxlovid in Reducing Severe COVID-19 and Mortality in High Risk Patients. Clin Infect Dis. 2022 Jun 2;ciac443. doi: 10.1093/cid/ciac443. Online ahead of print.

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