A pair of new studies describes the clinical benefits of two oral antiviral drugs in COVID-19 patients amid the Omicron period, one from Israel suggesting that nirmatrelvir-ritonavir (Paxlovid) reduced rates of hospitalization and death in people 65 years or older, and research from Hong Kong demonstrating that Paxlovid and molnupiravir lowered rates of death, disease progression, and the need for supplemental oxygen in older hospitalized patients.In the United States, the Food and Drug Administration (FDA) granted emergency use authorization for oral Paxlovid and molnupiravir for the treatment of patients with mild or moderate COVID-19 at high risk for severe illness within 5 days of symptom onset, regardless of vaccination status.Benefits strongest in 65-or-older groupYesterday in the New England Journal of Medicine, a team led by Clalit Health Services researchers in Tel Aviv published an observational, retrospective study on the outcomes of 109,254 eligible COVID-19 patients aged 40 years or older during the Omicron wave from Jan 9 to Mar 31, 2022.
Average age was 60 years, 60% were women, 39% were aged 65 or older, and 78% had previously had COVID-19, were vaccinated, or both.Of the 109,254 patients, 3,902 (4%) received at least one dose of Paxlovid, including 2,484 of 42,821 patients (6%) 65 years or older and 1,418 of 66,433 patients (2%) 40 to 64 years.
About 97% of Paxlovid recipients completed the 5-day treatment.The COVID-related hospitalization rate among patients aged 65 years or older was 14.7 per 100,000 person-days in Paxlovid recipients (11 of 2,484 patients [0.4%]), compared with 58.9 per 100,000 in those not receiving the drug (766 patients [1.9%]) (adjusted hazard ratio [aHR], 0.27; 95% confidence