Paxlovid May Reduce Risk of Long Covid In Eligible Patients, Study Finds

Participants who took Paxlovid within five days of their infection were 26% less likely to have a wide range of post-Covid symptoms 90 days after their infection. A large new study found that people who took the antiviral drug Paxlovid a few days after getting the coronavirus were less likely to have long Covid a few months later.

The results suggest that for older adults or people with certain health problems who are medically eligible for the antiviral, Paxlovid not only lowers the chance that they will be hospitalized or die from a coronavirus infection but also lowers the chance that they will have long-term symptoms.

Dr. Michael Peluso, an assistant professor of medicine at the University of California, San Francisco who was not involved in the new study, said, “The results are quite provocative and suggest that more research is needed right away on antiviral agents and how they affect long Covid.”

The study, which was posted online without being peer-reviewed, doesn’t say if antivirals might help other patients, like younger people or those who don’t have health problems that put them at high risk. And it doesn’t say anything about whether Paxlovid could be a treatment for the long Covid itself. Other researchers are looking into this question.

Long Covid Paxlovid Risk
Long Covid Paxlovid Risk

The researchers looked at the electronic medical records of 56,340 people who had at least one risk factor for a severe response to a coronavirus infection. They found that the 9,217 patients who took Paxlovid within five days of testing positive were 26% less likely to have a wide range of post-Covid symptoms about 90 days later than the 47,123 patients who did not get any antiviral or antibody treatment.

Patients in the Veterans Health Administration system who tested positive for the coronavirus between March 1 and June 30 of this year, when Omicron variants were the most common, were part of the study. The study found that people who took Paxlovid were less likely to get long Covid, regardless of whether they had been vaccinated or had been infected with the coronavirus before.

The people who wrote the study and other medical experts said that the results gave patients who are medically eligible another reason to take Paxlovid soon after getting infected. Even though Paxlovid has been shown to reduce hospitalizations and deaths in high-risk Covid patients, some people are afraid to take it because a small number of patients experience “Paxlovid rebound.” This is when Covid symptoms or positive test results come back after taking the drug. Several high-profile rebound cases, including those of President Biden and his top Covid adviser, Dr. Anthony Fauci, have added to the worry.

The study’s lead author, Dr. Ziyad Al-Aly, said, “For people who are already eligible to use Paxlovid, the choice is clear.” “Does Paxlovid give you a metallic taste? Does it have side effects? Can you get a rebound? Yes. But we have data that shows that Paxlovid lowers the risk of severe illness, which includes the risk of death and being hospitalized. And now we’ve found that there’s also less risk in the post-acute phase.”

Dr. Al-Aly and Dr. Peluso said that many people who were medically eligible for the drug either couldn’t get it or didn’t want it. Dr. Peluso said, “This study adds to the evidence that people with acute Covid should be given antivirals, especially if they have risk factors for a bad outcome.”

Most of the people who took part in the study were men and three-quarters of them were white. On average, they were about 65 years old, so the results may not apply to all patients. Still, Dr. Al-Aly said that getting Paxlovid was better than not getting it in terms of reducing risk in the acute phase and in the post-acute phase. This was true for people of any race, gender, age, or history of health problems.

When patients took Paxlovid, they were less likely to have 10 out of 12 long-term health problems, such as fatigue, shortness of breath, muscle pain, heart problems and neurocognitive problems like brain fog.

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Dr. Peluso said that one reason for the results could be that people who get very sick during the acute phase of an infection are more likely to have symptoms that last for a long time or to get new health problems a few weeks later. So, Paxlovid could prevent some post-Covid symptoms “linked to the damage done in the first two weeks of infection,” he said. This is because it could help patients avoid hospitalization and other serious early effects.

He also said that a good effect on long Covid seemed likely because “many of the risk factors for severe Covid are likely to overlap” with long Covid risk factors. Still, many people who only have mild symptoms when they first get Covid end up with it for a long time. The same is true for people who have never been at risk.

Dr. Al-Aly said that it’s possible that “giving your immune system a hand by suppressing that virus early on is kind of like nipping it in the bud,” lowering the risk of getting sick during both the acute and post-acute stages. That would support a theory that viral fragments that stay in the body and keep the immune system active could be one cause of long Covid.

For the study, Dr. Al-Aly, who is the head of research and development at the V.A. St. Louis Health Care System and a clinical epidemiologist at Washington University in St. Louis and his colleagues looked at the records of veteran administration patients who were over 60, overweight, smoked, or had conditions like cancer, heart disease, high blood pressure, or diabetes.

After about 90 days, patients who took Paxlovid—three pills twice a day for five days—were less likely to have 10 out of 12 long-term Covid health problems, such as fatigue, shortness of breath, muscle pain, blood clotting problems, heart problems and neurocognitive impairments like brain fog. Dr. Al-Aly said that there was no big difference between Paxlovid and non-Paxlovid patients for two problems after Covid: new-onset diabetes and coughing. He didn’t say why this was the case. The study found that for every 100 people who were given Paxlovid, there were 2.3 fewer cases of long Covid.

Patients who were in the worst health before their coronavirus infection—those who had more than five risk factors for getting a serious Covid illness—saw the biggest drop in their chance of getting long Covid. Patients who had received booster doses of vaccines had a lower risk reduction than those who had not been vaccinated or who had been vaccinated but had not received boosters. Dr. Al-Aly said this was probably because the boosters had already given them a stronger immune system.

Dr. Al-Aly said that there are many more questions about antivirals that need to be answered. For example, he asked if taking Paxlovid for more days or in higher doses would lower the risk of long Covid even more.

Dr. Peluso cautioned that in the study the treatment “did not completely eliminate post-Covid conditions” and said that at his hospital, “we have seen cases of people who develop long Covid despite antiviral treatment in early infection.”

So, he said, “much like vaccination, antiviral treatment during acute infection is likely to be one tool in the armamentarium to reduce the risk of post-Covid sequelae, but is unlikely to totally solve the problem.”

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