Prolonged Covid: Paxlovid reduces risk of prolonged Covid, Veterans Affairs study finds


Paxlovid, an antiviral pill that reduces the risk of hospitalization and death from Covid-19, also reduces the risk of prolonged Covid-19, according to a new study by researchers at the US Department of Veterans Affairs.

The study, published online Saturday, analyzed the electronic records of more than 56,000 veterans with Covid-19, including more than 9,000 who were treated with Paxlovide in the first five days of infection.

The analysis showed that people treated with Paxlovid were 26% less likely to develop several long-term conditions from Covid, including heart disease, blood disorders, fatigue, liver disease, kidney disease, muscle pain, neurocognitive impairment and shortness of breath. That corresponds to 2.3 fewer cases of long-term Covid conditions per 100 people three months after diagnosis. Paxlovid also reduced the risk of hospitalization or death after acute Covid-19.

In the analysis, there was no statistically significant association between taking Paxlovid and the risk of two long-term Covid conditions: cough and a new diagnosis of diabetes.

The study was published on the medRxiv preprint server and has not been peer-reviewed or published in a medical journal.

The patients included in the study had a mean age of 65 years and were diagnosed with Covid-19 between March 1 and June 30, 2022. All had at least one risk factor for progression to severe Covid-19, such as old age, diabetes or being a current smoker. Paxlovid reduced the risk of long-term Covid-19 in unvaccinated, vaccinated and boosted people, and in people with a previous Covid-19 infection or re-infection, the study said.

“Paxlovid reduces the risk of severe COVID-19 in the acute phase, and now we have evidence that it can help reduce the risk of long-term COVID-19,” said Dr. Ziyad Al-Aly, chief of research and development at VA St. Louis Health Care System and research leader said in a news release. “This treatment could be an important asset in combating the serious problem of prolonged COVID.”

The study has several limitations, including that most of the people included were white and male, which may limit its general relevance. The analysis only included Paxlovide use through the VA system and only considered prolonged Covid-12 conditions, although many people with prolonged Covid describe a wide range of symptoms.

Millions of people who have had Covid-19 experience a range of persistent symptoms since their initial illness, but there is no specific long-term treatment for Covid. Paxlovid is an antiviral treatment for Covid-19 that combines the newer antiviral nirmatrelvir with the older drug ritonavir. It is available for children under 12 and has been shown to significantly reduce the risk of hospitalization and death in people at risk of severe Covid-19.

The drug is made by Pfizer and is a pill taken over the course of five days. It works best if started within five days of the onset of symptoms; the researchers noted that it is not clear whether longer durations or higher doses or both could further reduce the risk of prolonged Covid-19 conditions, or whether starting Paxlovid after an acute Covid-19 illness would reduce the risk of prolonged Covid-19. The National Institutes of Health said last month it would launch a study of Paxlovid as a treatment for patients suffering from prolonged Covid.

“The overall evidence suggests the need to improve uptake and use of nirmatrelvir in the acute phase not only to prevent progression to severe acute disease, but also to reduce the risk of adverse post-acute health outcomes,” the authors said. It was written by VA research.