Paxlovid is Dead
Well, in outpatients, anyway.
Once upon a time, everyone clamoured for Paxlovid – back in the days where many had little acquired immunity from prior vaccinations or COVID, and SARS-CoV-2 was notably more lethal.
Those days are assuredly over – and likely have been for some time.
This is a publication of the results of PANORAMIC and CanTreatCOVID trials, two trials conducted in the U.K. and Canada in the 2021 to 2024 timeframe. We’ve already seen Paxlovid has no value in the “standard risk” population – and this revisits its utility in a higher-risk population, but a more modern cohort than those enrolled in EPIC-HR back in 2021.
The research summary infographic from NEJM probably summarizes this the best:
The big difference seen here – in EPIC-HR, 7% of the placebo cohort suffered hospitalization or death within 28 days, as opposed to the ~1% in these trials.
Nirmatrelvir-ritonavir definitely reduces viral load faster than placebo, and about 1 in 10 reported symptom improvement sooner as a result. Adverse events were reported frequently with nirmatrelvir-ritonavir, but very few were classified as serious.
Toss it on the hill with the influenza antivirals: in the ambulatory population, no clear benefit in serious outcomes, probably minimal benefit for symptomatic recovery.