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Far Fewer Deaths During Omicron for Seniors Treated With Paxlovid

Older patients treated with nirmatrelvir boosted by ritonavir (Paxlovid) for COVID-19 had lower rates of hospitalization and death weighed against those not treated with the antiviral through the Omicron wave, in accordance with an observational retrospective cohort study from Israel.

Among patients ages 65 and older, the rate of hospitalization because of COVID was 14.7 cases per 100,000 person-days for the two 2,484 patients who received nirmatrelvir weighed against 58.9 cases per 100,000 person-days for the 40,337 untreated patients (adjusted HR 0.27, 95% CI 0.15-0.49), reported Ronen Arbel, PhD, of Clalit Health Services in Tel Aviv, and colleagues.

Death occurred in two nirmatrelvir-treated patients and in 158 untreated patients (aHR 0.21, 95% CI 0.05-0.82), they said in the New England Journal of Medicine.

For patients ages 40 to 64, the rate of hospitalization was 15.2 cases per 100,000 person-days among treated patients and 15.8 cases per 100,000 person-days among untreated patients (aHR 0.74, 95% CI 0.35-1.58). Deaths were similar because of this age group aswell (aHR 1.32, 95% CI 0.16-10.75).

“Our results comply with CDC guidelines to take care of high-risk patients, prioritizing those above 65,” Arbel told MedPage Today within an email. “No proof benefit was within younger adults.”

However, “whether to give an individual nirmatrelvir is really a clinical decision,” he added. “It will not be limited [to those over 65], but instead a factor to take into account in the chance assessment of patients predicated on their risk profile and extra clinical considerations, including symptoms.”

Furthermore, the study discovered that older patients who had immunity either from vaccination or previous infection also had better outcomes. Hospitalization was required in 1% of these with immunity (505 of 39,503) weighed against 8% (277 of 3,318) who had no immunity.

Arbel and co-authors designed this study to judge the potency of nirmatrelvir in a vaccinated population through the Omicron wave to compare their results with that of the EPIC-HR trial, which showed an 89% reduced threat of progression to severe disease with nirmatrelvir weighed against placebo through the Delta wave.

“We expected that the outcomes would change from the randomized controlled trial because the threat of severe disease is a lot low in Omicron,” Arbel said.

Furthermore, both study populations were different, “because the the greater part of our patients were vaccinated,” he explained. “In the subgroup of unvaccinated patients over 65 years, we saw comparable leads to the randomized controlled trial.”

Because of this study, Arbel and team included all members of Clalit Health Services ages 40 and older in the beginning of the study period, who have been permitted receive nirmatrelvir. A complete of 109,254 patients met the eligibility criteria, of whom 3,902 received nirmatrelvir through the study period (Jan. 9 to March 31, 2022). Mean age was 60 years, 39% were 65 and older, and 60% were women.

Treatment was presented with a mean 2 days following a positive test (range 1 to 5 days), and 97% completed the 5-day span of nirmatrelvir.

More comorbidities were reported in younger group versus the older patients, including obesity (42% vs 34%), hypertension (49% vs 33%), and diabetes (40% vs 26%).

“Indeed, younger patients had more comorbidities since to become qualified to receive therapy as of this age, you had a need to have additional risk factors for severe outcomes,” Arbel noted.

The authors acknowledged that residual confounders could have introduced bias to their study.

  • author['full_name']

    Ingrid Hein is really a staff writer for MedPage Today covering infectious disease. She’s been a medical reporter for greater than a decade. Follow

Disclosures

Arbel reported no disclosures. Some co-authors disclosed relationships with Pfizer unrelated to the present study.

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