Pregnant women can safely take the antiviral drug Paxlovid to reduce the risk of serious COVID-19 pregnancy or fetal complications, according to a small study published yesterday in JAMA Network Open.
Johns Hopkins researchers conducted a case series of 47 pregnant women with mild or moderate COVID-19 who were given nirmatrelvir-ritonavir (Paxlovid) and delivered at the Johns Hopkins Health System from Dec 22, 2021, to Aug 20, 2022. Median patient age was 34 years, 17% were Black, and 11% were Hispanic.
Sixteen patients (34.0%) had received the primary COVID-19 vaccination series, 21 (44.7%) had received one booster, and 3 (6.4%) had gotten two boosters. Thirty patients (63.8%) given Paxlovid had an underlying illness that may have put them at high risk for severe COVID-19.
The women were given Paxlovid a median of 1 day after COVID-19 symptom onset. Two patients (4.3%) didn't finish the course because of adverse effects.
Of the 47 patients, 25 (53.2%) delivered after Paxlovid treatment, and 12 (48.0%) of them had cesarean deliveries, of which 9 (75.0%) had been scheduled and weren't related to treatment. Two women (4.3%) were hospitalized for comorbidity-related conditions.
"In this case series, pregnant patients who were treated with nirmatrelvir and ritonavir tolerated treatment well, although there was an unexpectedly high rate of cesarean deliveries," the study authors wrote.
In a Johns Hopkins Medicine news release, co-senior author Irina Burd, MD, PhD, now at the University of Maryland, said that the clinical trials that enabled Paxlovid's emergency use authorization showed that infected participants who took the drug were 89% less likely to become severely ill or die than nonrecipients. "However, people who were pregnant weren’t among the participants, and pregnancy is now known to be a condition placing patients at risk of severe disease," she said.
Co-senior author Kelly Gebo, MD, MPH, said that although the results need confirmation, "We feel that even at this time, the medication should be strongly considered for pregnant patients who are unvaccinated or at risk for progression to severe COVID disease or not likely to have drug-drug interactions."