MedPage Today It’s not all about drug-drug interactions, experts say.
Recent evidence is piling up that many people at high risk for severe COVID-19 don’t receive nirmatrelvir/ritonavir (Paxlovid) — or any outpatient antiviral treatment — when diagnosed with a SARS-CoV-2 infection. MedPage Today looked at new studies and talked to experts to find out why.
In a new observational study, people on Medicare who were at highest risk for severe COVID-19 were actually less likely to receive outpatient antiviral treatments, such as nirmatrelvir/ritonavir, than Medicare beneficiaries at lower risk. For example, individuals 90 years and older were 36% less likely to receive the drugs compared with those ages 65 to 69 years (adjusted odds ratio [aOR] 0.64, 95% CI 0.62-0.65).
Moreover, when researchers performed a simulation analysis of data, they found that reallocation of nirmatrelvir/ritonavir according to patient risk could have prevented about 10,300 hospitalizations and 16,500 deaths in 2022 alone, Michael Barnett, MD, from the Harvard T.H. Chan School of Public Health in Boston, and colleagues reported in JAMA Health Forum
Especially concerning was the finding that people in nursing homes were less likely to receive any COVID-19 treatment compared to people living in the community (aOR 0.78, 95% CI 0.75-0.81), despite the fact that nursing home residents were more likely to be tested for COVID-19 or have a COVID-19 related healthcare visit, the authors wrote.
Differences could not be explained by contraindications to nirmatrelvir/ritonavir, drug-drug interactions, access to ambulatory visits, variation in COVID-19 testing, or geographic variation. Given that nirmatrelvir/ritonavir treatment was available at no cost in 2022 when the study was conducted, cost barriers did not explain the findings, Barnett told MedPage Today.