Paxlovid tied to 44% drop in risk of COVID hospitalization, death in older adults

Older woman with telehealth consultation

Dmitry Belyaev / iStock

The antiviral drug Paxlovid drove down the risk of COVID-19 hospitalization or death by 44% in a highly vaccinated group of US adults aged 50 and older, suggests a large study published today in the Annals of Internal Medicine.

A team led by Brigham and Women's Hospital researchers studied the risk of hospitalization by 14 days and death by 28 days among 44,551 nonhospitalized COVID-19 patients aged 50 and older prescribed Paxlovid (nirmatrelvir-ritonavir) amid Omicron variant predominance from Jan 1 to Jul 17, 2022.

A total of 28.1% of patients were prescribed Paxlovid, and 71.9% were not. Of all participants, 90.3% had received at least three COVID-19 vaccine doses.

Hispanic, Black patients less likely to receive Paxlovid

Patients taking Paxlovid were more likely to be older and vaccinated and to have more underlying illnesses than those not taking the drug. Hispanic (adjusted odds ratio [aOR], 0.77) and Black (aOR, 0.53) patients were less likely than their White peers (by 23% and 47%, respectively) to be prescribed Paxlovid.

However, participants living in neighborhoods in the highest quartile of disadvantage were given Paxlovid prescriptions at similar rates as those living in more advantaged areas.

Composite hospitalization or death occurred in 0.55% of the Paxlovid group and 0.97% of the non-Paxlovid group (adjusted risk ratio [aRR], 0.56). Paxlovid recipients were at a 40% lower risk for hospitalization (aRR, 0.60) and a 71% lower risk of death (aRR, 0.29). No hospitalizations were attributable to viral rebound, or the return of infection and symptoms after an apparent recovery among Paxlovid recipients.


Paxlovid recipients were at a 40% lower risk for hospitalization and a 71% lower risk of death.

The risk reductions were comparable across age-groups, comorbidity scores, and body mass index (BMI) groups, but Paxlovid was tied to increased protection among the partially vaccinated (81% risk reduction) and those who received their most recent vaccine dose more than 20 weeks earlier.

Outreach, testing, and communication

"The observed rate of hospitalization or death was low (1 percent) among outpatients diagnosed with COVID-19, but we found that Paxlovid was still associated with a proportional reduction of risk for hospitalization of about 50 percent across patient groups with different baseline risk levels," corresponding author Scott Dryden-Peterson, MD, said in a Brigham and Women's news release.

Senior author Ann Woolley, MD, MPH, said the study "incorporated and built on existing systems and has allowed us to feel, programmatically within the Mass General Brigham system, and clinically within Infectious Diseases, that we were doing the right thing by prescribing Paxlovid to eligible patients."

Dryden-Peterson said that the results highlight the importance of Paxlovid at a time when no monoclonal antibody therapies have been shown to be effective against Omicron: "Our findings suggest that Paxlovid can save lives, and it can have a real impact on keeping hospital beds available for the treatment of other conditions.

"The opportunity to prevent COVID-19 hospitalizations is not there unless people know that they're positive, so we have ongoing efforts to do outreach, make testing available, and communicate to the highest-risk patients that they may benefit from Paxlovid or another antiviral treatment option."

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