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Paxlovid Advantageous for Elderly COVID-19 Patients, Ineffective in Younger Adults
An Israeli study found that patients over 65 years of age treated with Paxlovid, Pfizer’s protease inhibitor, were significantly less likely to be hospitalized or die due to COVID-19 infection.
A study published on September 1st in the New England Journal of Medicine tracking health data from 109,254 Israeli adults found a 73% reduction in hospitalization and a 79% reduction in COVID-19 mortality in patients over 65 who were treated with Pfizer’s protease inhibitor Paxlovid.
Of the 40,337 untreated patients over 65, there were 158 deaths due to COVID-19, while only two of the 2,484 Paxlovid-treated patients died. And for those aged 40–64, only one of the 1,418 treated patients died, while 16 of the 65,015 untreated patients died.
The observational cohort study used data from Clalit Health Services, which covers nearly 52% of Israel’s population. To meet the study’s requirements, participants had to be at least 40 years old, considered high-risk for severe disease, and diagnosed with COVID-19 at an outpatient facility after February 24th, 2022.
During the study period, the Omicron subvariant of COVID-19 was dominant in Israel, indicating that Paxlovid is effective at treating Omicron infections in patients older than 65. However, the study did not show that Paxlovid had any effect on the younger population of patients aged 40–64.
The study also exhibited a lower percentage of avoided hospitalizations than what was demonstrated by Pfizer’s initial Paxlovid EPIC-HR study, which found an 89% reduction in hospitalization. Another study with even stronger results conducted by Epic Research suggested that patients were five times less likely to be hospitalized and ten times less likely to die if given a course of Paxlovid.
Since its authorization in December of 2021, Paxlovid has experienced some road bumps. The CDC warned clinicians about the potential for rebound cases in patients using Paxlovid after treated individuals tested positive for coronavirus in the days after their regimen ended. FDA officials have since asked Pfizer to investigate the phenomenon and see if an extended course may reduce instances of COVID-19 rebound. The federal government’s supply of Paxlovid pills is also expected to expire by the middle of next year, leaving questions about the antiviral's future after it enters the commercial market.
Compared to other options, Paxlovid remains an essential tool in the fight against COVID-19. In a smaller double-blind placebo-controlled trial, Merck’s antiviral pill, molnupiravir, reduced the risk of hospitalization or death by 30%, a minor effect compared to Pfizer’s competing antiviral pill. Last year, the federal government purchased 1.7 million courses of molnupiravir in addition to the 10 million doses of Paxlovid already purchased.
