Studies Investigate Whether Antivirals Like Paxlovid May Prevent Long COVID

This study, published in JAMA, investigates whether antiviral treatments like Paxlovid (nirmatrelvir combined with ritonavir) and Lagevrio (molnupiravir) might prevent Long COVID. Long COVID is defined by the U.S. government as health issues that continue or develop 4 weeks or more after an initial SARS-CoV-2 infection.

Key Highlights:

  1. Background: Long COVID affects a significant portion of the population, with about 7% of the US population having experienced it and more than 3% currently living with it. The study’s significance lies in exploring whether existing COVID-19 antiviral treatments can reduce the risk of developing Long COVID.
  2. First Study – Elderly Patients: This study involved more than 2 million adults aged 65 or older who were diagnosed with COVID-19. About 20% received nirmatrelvir, and 2.6% received molnupiravir. The results showed:
    • Roughly 313,000 participants developed Long COVID, with symptoms like cough, fatigue, and shortness of breath.
    • Nirmatrelvir and molnupiravir users had a 13% and 8% lower relative risk, respectively, of developing Long COVID compared to those who received no treatment.
    • However, the absolute risk reduction was small: 12% of nirmatrelvir users and 13.7% of molnupiravir users developed Long COVID, compared to 14.5% in the untreated group.
  3. Second Study – Veterans: This study examined 9,593 veterans treated with nirmatrelvir-ritonavir, comparing them to a control group. The findings were more limited:
    • Nirmatrelvir-ritonavir was associated with reduced risk of thromboembolic events (blood clots) only.
    • The study did not find definitive evidence of reduced risk for many other post-COVID-19 conditions.
  4. General Observations:
    • These studies suggest some protection against Long COVID from antiviral use during acute COVID-19, especially in older adults. However, generalizability to younger populations remains unknown.
    • Vaccination against COVID-19 may reduce the risk of Long COVID, even in cases of breakthrough infections.
  5. Limitations and Future Directions:
    • The studies have been mostly observational and retrospective, focused mainly on older adults.
    • Clinical trials are needed for more conclusive evidence, especially considering ethical concerns in randomizing patients to no treatment.
  6. Conclusion: The findings provide a step towards understanding the potential benefits of antivirals in preventing Long COVID. However, more research is needed to optimize their effectiveness.

This summary provides an overview of the study’s key findings and implications, crucial for understanding the potential role of antiviral treatments in preventing Long COVID.

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