From the Guidelines
Paxlovid is recommended for individuals with mild COVID-19 symptoms who are at high risk for progressing to severe disease, but not for those at low risk. According to the American College of Physicians' living, rapid practice points for the outpatient treatment of confirmed COVID-19 1, nirmatrelvir–ritonavir combination therapy, also known as Paxlovid, is supported for use in 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 key factors to consider when deciding whether to recommend Paxlovid include:
- The patient's risk level for severe disease, with high-risk individuals including older adults, unvaccinated individuals, and those with underlying health conditions such as heart disease, lung disease, diabetes, obesity, or immunocompromised states
- The timing of treatment, with Paxlovid working best when started within 5 days of symptom onset
- The potential benefits and risks of treatment, including the reduction of hospitalization and death, as well as potential side effects such as altered taste, diarrhea, and liver problems For those with mild symptoms who are not in high-risk categories, supportive care including rest, hydration, and over-the-counter medications for symptom relief is typically sufficient, as the benefits of Paxlovid may not outweigh the potential risks 1.
From the FDA Drug Label
PAXLOVID which includes nirmatrelvir, a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) main protease (Mpro: also referred to as 3CLpro or nsp5 protease) inhibitor, and ritonavir, an HIV-1 protease inhibitor and CYP3A inhibitor, 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. 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.
Paxlovid is recommended for the treatment of mild-to-moderate COVID-19 in adults at high risk for progression to severe COVID-19.
- The high risk criteria are not explicitly defined in the provided text, but the indication is for mild-to-moderate COVID-19.
- Mild COVID-19 symptoms are included in the indication, as long as the patient is at high risk for progression to severe COVID-19. 2 2 2
From the Research
COVID-19 Treatment with Paxlovid
- Paxlovid, also known as nirmatrelvir-ritonavir, is an oral antiviral medication used to treat mild to moderate COVID-19 in patients at risk for progression 3.
- The medication has been shown to reduce the risk of hospitalization and death in patients with COVID-19, especially when started within 5 days of symptom onset 3, 4, 5.
- Studies have compared the effectiveness of Paxlovid to other antiviral medications, such as molnupiravir and remdesivir, and found that Paxlovid may be more effective in reducing the risk of hospital admission 5.
- In patients with mild COVID-19 symptoms, Paxlovid may still be recommended to prevent progression to severe disease, especially in those with underlying health conditions or other risk factors 3, 6.
Effectiveness and Tolerability of Paxlovid
- Real-world studies have shown that Paxlovid is effective and well-tolerated in patients with mild to moderate COVID-19, with a low risk of serious adverse effects 4, 6.
- Paxlovid has been compared to other antiviral medications in terms of effectiveness and tolerability, and has been found to have a similar effectiveness in containing the progression of the infection to severe COVID-19 6.
- The choice of antiviral medication, including Paxlovid, should be based on individual patient factors, such as underlying health conditions and risk factors for progression to severe disease 3, 6.
Recommendations for Use
- Paxlovid is recommended for use in patients with mild to moderate COVID-19 who are at risk for progression to severe disease, especially when started within 5 days of symptom onset 3, 5.
- The medication should be used in accordance with the recommended dosage and treatment duration, and under the guidance of a healthcare professional 3, 6.