In the United States, only people with certain medical conditions at higher risk of developing severe COVID-19 are currently eligible to receive the drug.
Now, a new study suggests that expanding eligibility to include all people with COVID-19 could benefit everyone.
Canadian researchers studied 41 trials that covered more than 18,000 people with non-severe COVID-19. They reported that taking Paxlovid likely led to 46 fewer hospital admissions per 1,000 cases compared to people who received standard care or a placebo.
The researchers also found that the antiviral drug molnupiravir may also be somewhat beneficial, resulting in 16 fewer admissions per 1,000 patients.
Dr, Jimmy Johannes, a pulmonologist and critical care medicine specialist at MemorialCare Long Beach Medical Center in California, said the findings didn’t surprise him, as the findings are in line with his expectations based on the pivotal clinical trials for both Paxlovid and Molnupiravir. He further said that early testing to confirm a COVID-19 infection is key and also that there is a need for more awareness among the public and among healthcare providers that these antiviral treatments work best early in the course of a COVID-19 infection.
But meta-analyses have limitations, experts advise caution as the speed of COVID-19’s mutations means we don’t know that results that were true for one variant of the virus in this case, primarily last year’s Delta variant are valid for another.
In a commentary in the Canadian Medical Association Journal, where this study was published, reviewers noted much the same, highlighting the crucial importance of vaccination status as a primary prophylactic against severe COVID-19.
“[Paxlovid] is likely less effective in the real-world setting than suggested by the findings of the related network meta-analysis,” they wrote. “A recent observational study examining the effectiveness of [Paxlovid] among vaccinated patients infected with Omicron and without evidence of previous infection concluded that it was effective in reducing severe COVID-19.” However, they noted that another story indicated that “vaccination alone was as or more effective than [Paxlovid] and that the effectiveness of [Paxlovid] did not vary by vaccination status.”
They also noted that Paxlovid manufacturer Pfizer recently stopped a trial of vaccinated individuals due to a low rate of hospitalization or death in the standard-risk population.
Experts say another reason doctors must be cautious in prescribing Paxlovid is its large number of interactions with other drugs and supplements.
“General availability of Paxlovid needs to be limited due to potentially serious interactions with many commonly used medications,” Cutler said. “This means that a patient’s use of herbs, vitamins, and supplements as well as prescription medications needs to be reviewed prior to safely prescribing Paxlovid.”
But whether or not Paxlovid’s availability is expanded in the United States, experts say antivirals will remain a piece of our COVID-fighting arsenal.