Safety and Efficacy of Paxlovid Against Omicron Variants of Coronavirus Disease 2019 in Elderly Patients

Abstract

Introduction Elderly patients are the most affected and vulnerable to COVID-19 and effective therapeutic interventions are urgently required. We clarified the safety and efficacy of Paxlovid in the treatment of elderly patients with coronavirus disease 2019 (COVID-19). Methods Patients aged over 60 years and with mild to moderate COVID-19 were admitted to the Zhongshan Hospital MinHang MeiLong Branch, Fudan University and received either Paxlovid treatment or only conventional therapy, between April 1 and May 31, 2022. Viral shedding time, duration of hospital stay, disease progression, and adverse events were analyzed, and multivariate Cox regression analysis was performed to detect the independent high-risk factors for COVID-19 progression in the patients. Results A total of 163 (82 and 81 in the treatment and control groups, respectively) patients had a median age of 82 (71–89) years, and 89.0% had at least one concomitant disease. The duration of hospitalization reduced from 15 to 13 days, and viral shedding time reduced from 20 to 16.5 days after Paxlovid treatment. The differences of these two variables between the groups were significant ( p < 0.01). Moreover, no serious adverse events or obvious changes in laboratory test results were observed in patients treated with Paxlovid. One patient (1.2%) treated with Paxlovid experienced rebound 56 days after negative measurement. Multivariate analysis showed that Paxlovid therapy, age, hemoglobin, and nucleic acid Ct values at admission were independent risk factors for hospitalization within 14 days, and the differences were significant ( p < 0.01). Conclusion The use of Paxlovid in elderly patients may promote recovery from COVID-19 and reduce the viral load without adverse events. Clinical trial registration www.ClinicalTrials.gov , ID: ChiCTR2200066990. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-023-00760-x.

COVID-19 or seasonal influenza? How to distinguish in people younger than 65 years old — — A retrospective observational cohort study comparing the 2009 pandemic influenza A H1N1 with 2022 SARS-CoV-2 Omicron BA.2 outbreaks in China

“…Due to the younger age and fewer underlying diseases in the H1N1 group, the matched Omicron group also had such characteristics. The median age of the Omicron group was 21 [11,26] years, which was significantly lower than the median age of 36 [25,48] years in our previous study [20] . The younger age of the H1N1 group may be related to the characteristics of the virus [21] (all 127 H1N1 influenza patients were younger than 65 years old ).…”

“…For Omicron patients, fever is positively correlated with the time of NAN. All these suggest that if H1N1 patients have elevated hemogram and Omicron patients have fever, we should be prepared for a longer course of disease and early use of antiviral drugs may be helpful for shortening the time of NAN [47,48] .…”

Evaluating Nirmatrelvir-Ritonavir (Paxlovid®) in Outpatient COVID-19 Treatment: Safety, Tolerability, and Adherence Insights from Primary Healthcare Clinics

“…According to the protocols set by the Ministry of Health Malaysia [9], patients in category 2 are managed within the primary care setting, while those in categories 3 to 5 necessitate hospitalization. Given the heightened vulnerability of the elderly to COVID-19 and the rapid symptom escalation in the later stages of the disease, they are more likely to be swiftly transitioned to intensive care, often requiring mechanical ventilation [17]. This operational dynamic potentially explains the lower representation of patients above 60 in the study cohort and, consequently, the lower incidence of ADRs reported in this age group.…”

Effectiveness of nirmatrelvir‐ritonavir on severe outcomes of COVID‐19 in the era of vaccination and Omicron: An updated meta‐analysis

“…The most heterogeneous results were observed for disease progression, with some studies reporting a statistically significant protective effect of NR, while other studies T A B L E 2 Comparison of the pooled risk ratios (RR) for the different outcomes, including sensitivity analyses and subgroup analysis. Included studies were 34,38,40,41,43,46,47,50,[52][53][54]58,[62][63][64][65][66] observed (nonsignificant) higher risk of progression with administration of NR.…”

“…Moreover, although NR was marketed for outpatient treatment of patients with mild to moderate disease at high risk of progression, some studies assessed the effect of NR on hospitalized patients 40,46,54,[60][61][62] or did not exclude patients at standard risk for severe disease. 35,36,38,40,43,45,57,61 Nonetheless, our sensitivity analysis limiting the analysis to only the marketed patient population of high-risk outpatients showed similar pooled RRs.…”