Paxlovid may reduce risk of long-term Covid in eligible patients, study finds

Paxlovid may reduce risk of long-term Covid in eligible patients, study finds

People who took the antiviral drug Paxlovid within days of being infected with the coronavirus were less likely to have long-term Covid months later, a large a new study found.

The findings suggest that for people who are medically eligible for antiviral drugs — older adults or people with certain health conditions — Paxlovid not only reduces the odds of being hospitalized or dying from a coronavirus infection, but also reduces the risk of long-term infection. symptoms.

“The results are quite provocative and suggest that further research into antiviral agents and their effects on long-term Covid is urgently needed,” said Dr. Michael Peluso, an assistant professor of medicine at the University of California, San Francisco, who was not involved in the new research.

The study, which was published online without peer review, did not indicate whether antiviral drugs might be useful for other patients, such as younger people or those without high-risk medical conditions. And it doesn’t give any indication whether Paxlovid could be a long-term treatment for Covid, the question arises investigated by other researchers.

Researchers analyzed the electronic medical records of 56,340 patients who had at least one risk factor for a severe response to coronavirus infection. They found that 9,217 patients who took Paxlovid within five days of testing positive were 26 percent less likely to have a wide range of post-Covid symptoms about 90 days later than 47,123 patients who did not receive antiviral or antibody treatment.

The patients were part of the Veterans Health Administration system and tested positive for the coronavirus between March 1 and June 30 of this year, a period when the Omicron variants dominated. Those taking Paxlovid had a reduced risk of long-term Covid regardless of vaccination status or whether they had previously been infected with the coronavirus, the study found.

The study authors and other medical experts said the findings provided additional motivation for medically eligible patients to take Paxlovid shortly after infection. Although Paxlovid has been shown to be effective in reducing hospitalizations and deaths in patients at high risk of Covid, some people have become wary of the drug because a small percentage of patients experience “Paxlovid rebound” — recurrence of Covid symptoms or positive test results. Several high-profile recoveries, including President Biden and his top Covid adviser, Dr. Anthony Fauci, is an added concern.

“For people who are already eligible for Paxlovid, to me the choice is really clear,” said Dr. Ziyad Al-Aly, senior author of the study. “Do you have a metallic taste, do you have side effects from Paxlovide, can you come back? Yes. But we have evidence to suggest that Paxlovid in the acute phase reduces the risk of severe disease, which means the risk of death and hospitalization. And now we show in the post-acute phase, there is also a reduction in risk.”

dr. Al-Aly et al. Peluso said many patients who are eligible for treatment either do not get access to the drug or refuse it. “This study provides further evidence for treating people who have acute Covid with antiviral drugs, especially if they have risk factors for severe outcomes,” said Dr. Peluso.

Most of the study participants were men, three-quarters were white, and their average age was about 65, so the findings may not apply to all patients. Nevertheless, dr. Al-Aly said, regardless of race, gender, age or type of pre-existing medical problem, “getting Paxlovid was actually better than not getting it in terms of reducing risk in the acute phase and reducing risk in the post-acute phase. stage.”

One explanation for the findings, said Dr. Peluso, is linked to the fact that people who become seriously ill in the acute phase of infection are more likely to have long-term symptoms or develop new health problems weeks later. So by helping patients avoid hospitalization and other serious early consequences, Paxlovid could prevent some post-Covid symptoms “related to the damage done in the first few weeks of infection,” he explained.

He added that another reason a beneficial effect on long-term Covid seems logical is that “many risk factors for severe Covid are likely to overlap” with risk factors for long-term Covid. However, many people who have only mild symptoms in their initial infections go on to develop Covid, as do people who have no previous risk factors.

dr. Al-Aly said it’s possible to “give your immune system a hand by suppressing that virus initially, really like nipping it in the bud, producing a reduction in risk for the acute phase as well as the post-acute phase.” This would support the theory that one of the causes of long-lasting Covid may be fragments of the virus that persist in the body, keeping the immune system activated.

For this study, Dr. Al-Aly, head of research and development at VA St. Louis Health Care System and a clinical epidemiologist at Washington University in St. Louis, and colleagues evaluated patient records of veterans whose risk factors included being over age 60, overweight, smoking, or having conditions such as cancer, heart disease, hypertension, or diabetes.

After about 90 days, patients taking Paxlovid — three pills twice a day for five days — were less likely to experience 10 of 12 long-term health problems from Covid, including fatigue, shortness of breath, muscle pain, blood clotting problems, cardiovascular problems and neurocognitive impairments such as brain fog. For unclear reasons, said dr. Al-Aly, there was no significant difference between Paxlovid and non-Paxlovid patients for two post-Covid problems: new-onset diabetes and cough.

Overall, for every 100 patients treated with Paxlovide, there were 2.3 fewer cases of long-term Covid, the study found.

Patients with the worst pre-coronavirus health status – with more than five risk factors for serious illness from Covid – experienced the greatest reduction in long-term Covid risk. Patients who received booster doses of vaccines experienced less risk reduction than those who were unvaccinated or vaccinated without a booster, possibly, said Dr. Al-Aly, because the dispensers have already given them greater protection of the immune system.

dr. Al-Aly said many additional questions about antiviral drugs should be investigated, such as whether taking Paxlovide for more days or at higher doses would further reduce the risk of long-term Covid.

dr. Peluso cautioned that in the study the treatment “did not completely eliminate the post-Covid condition” and said that at his hospital “we have seen cases of people who develop Covid for a long time despite antiviral treatment in early infection”.

So, he said, “like vaccination, antiviral treatment during acute infection is likely to be one of the tools in the armamentarium to reduce the risk of post-Covid sequelae, but is unlikely to completely solve the problem.”

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