From the Guidelines
Paxlovid does not cure COVID-19, but it is an effective antiviral treatment that can reduce the risk of severe illness, hospitalization, and death in high-risk patients. According to the most recent evidence from the American College of Physicians 1, Paxlovid, which consists of two medications: nirmatrelvir and ritonavir, is recommended to treat symptomatic patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 5 days of the onset of symptoms and at a high risk for progressing to severe disease.
The standard treatment regimen for Paxlovid is 300mg nirmatrelvir (two 150mg tablets) with 100mg ritonavir (one tablet) taken together twice daily for five days. It is essential to initiate treatment within 5 days of symptom onset for maximum effectiveness. Paxlovid works by preventing the virus from replicating in the body, which gives the immune system time to fight the infection.
Some key points to consider when prescribing Paxlovid include:
- Potential interactions with common medications, so patients should inform their healthcare provider about all medications they're taking
- The possibility of a "rebound" of symptoms after completing treatment, which does not indicate treatment failure
- The importance of vaccination in developing immunity against the virus, even if treatment is available
The American College of Physicians recommends considering Paxlovid for high-risk patients with mild to moderate COVID-19, as stated in their living, rapid practice points 1. However, the most recent and highest-quality study 1 supports the use of Paxlovid in this context, making it the primary recommendation for reducing the risk of severe illness, hospitalization, and death in high-risk patients.
From the FDA Drug Label
PAXLOVID is indicated for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adults who are at high risk for progression to severe COVID-19, including hospitalization or death. The FDA drug label does not answer the question of whether Paxlovid cures COVID-19, it only indicates that it is used for treatment of mild-to-moderate COVID-19 in adults at high risk for progression to severe COVID-19. Key points:
- The label indicates the drug is for treatment, not a cure.
- The label does not provide information on the drug's ability to cure COVID-19 2, 2, 2.
From the Research
Effectiveness of Paxlovid in Treating COVID-19
- Paxlovid (nirmatrelvir/ritonavir) has been shown to be effective in reducing the risk of hospitalization and death in patients with COVID-19 who are at high risk for severe disease 3, 4, 5, 6, 7.
- Studies have demonstrated that Paxlovid treatment within 5 days of COVID-19 symptom onset can reduce the risk of hospitalization by 26-39% and death by 61-73% 4, 7.
- The effectiveness of Paxlovid has been observed in various patient populations, including those with underlying medical conditions and those who are vaccinated or unvaccinated 4, 5.
Reduction in Long COVID Risk
- Paxlovid treatment has been associated with a reduced risk of Long COVID, with a hazard ratio of 0.88 (95% CI, 0.87 to 0.89) and an absolute risk reduction of 2.99 events per 100 persons (95% CI, 2.65 to 3.32) 3.
- However, the reduction in Long COVID risk was not observed in low-risk patients, suggesting that Paxlovid may be more effective in preventing Long COVID in high-risk patients 3.
Disparities in Paxlovid Treatment
- Disparities in Paxlovid treatment have been observed, with lower rates of treatment among black and Hispanic or Latino patients, and within socially vulnerable communities 4.
- These disparities may imply that the benefits of Paxlovid's effectiveness are not equitably distributed, highlighting the need for targeted efforts to improve access to Paxlovid treatment in underserved populations 4.