Should vaccinated adults ages 50 and under who get Covid-19 take Paxlovid? That was what I wanted to know. Last year, I’d started to notice that young, healthy, and vaccinated people were taking the drug frequently, even though it had only ever been
As a purely clinical doctor, practicing 100% of the time and gleaning knowledge from experience, as well as a careful following of the literature, I have been long on Paxlovid since it first came out.
Among the headlines and conclusions that stick in my mind:
90% reduction in viral load.
At least 25% reduction in long Covid.
Post covid conditions often mediated by persistent pockets of virus and incomplete clearance.
Most studies are concerned with hospitalization and death. I think the long term risk reductions in post covid conditions, cardiovascular disease, neurological syndromes, etc will be difficult to measure and prove, especially as people suffer repeated insults from repeat infections... over decades.
So I’m staying long on Paxlovid unless I hear otherwise, and glad to hear another vote here, even if just reducing the worst short term outcomes. My bias as a primary care physician is playing the long long game with my patients... and it’s hard for any of us to see that in the present. So we do our best with the evidence and a dash of intuition before everything is fully known.
The viral load piece just is meh for me. Lots of things reduce viral load (a point that Peter Palese pounded on me in a lovely conversation we had at NASEM last week). The reduction piece would be really nice...but I just don't see strong enough data for that. If that ends up being the case...that'd be great. If I knew for sure there were no harms, I'd say go for it. But I think we all know that we need to balance that. So I wait...
Thank you for conducting and sharing this research. It sounds like the asthma/copd patients avoided negative outcomes whether or not they took Paxlovid --or was it that they experienced negative outcomes whether or not they took Paxlovid? Did you separate out asthma patients by subtype? I have read some research that suggests that some forms of asthma are protective while others are not. Are you or others planning to look at the efficacy of Paxlovid in those over 50 who are vaccinated broken down by pre-existing condition?
A question, any findings either way for people who are immunocompromised due to taking immune suppressing biologic meds such as Enbrel which u packed their response to vaccination, including bivalent booster? Many thanks
Do you have data on whether any of the patients were pregnant? (Of course as an OBGYN that’s the first thing I want to know, especially since pregnancy is generally a huge gap in the initial research on any drug.)
Congrats on the pub! I’m wondering if you have any thoughts on some of the other comorbidity subgroup analyses, e.g., BMI/obesity or diabetes? We heard a lot about those groups having poorer outcomes in the pre-vaccine era.
Perhaps the N of those subgroups was too low to analyze?
Members of my family in their late 30/ early 40’s got Paxlovid last month. I understood why one did-- primary immune deficiency, but the other just had asthma. Metro Boston area. The person with the immune deficiency recovered slowly. Very timely and important information.
We all do bring our bias to health care-- receiving/providing and researching. I always share a great New Yorker article about how most studies can’t be replicated when someone is dogmatic about “evidence”.
Congratulations! Well done!
Thanks! First emails to Sax were September 2022. 10 months later...voila. lol
Nice! And congratulations on CID.
As a purely clinical doctor, practicing 100% of the time and gleaning knowledge from experience, as well as a careful following of the literature, I have been long on Paxlovid since it first came out.
Among the headlines and conclusions that stick in my mind:
90% reduction in viral load.
At least 25% reduction in long Covid.
Post covid conditions often mediated by persistent pockets of virus and incomplete clearance.
Most studies are concerned with hospitalization and death. I think the long term risk reductions in post covid conditions, cardiovascular disease, neurological syndromes, etc will be difficult to measure and prove, especially as people suffer repeated insults from repeat infections... over decades.
So I’m staying long on Paxlovid unless I hear otherwise, and glad to hear another vote here, even if just reducing the worst short term outcomes. My bias as a primary care physician is playing the long long game with my patients... and it’s hard for any of us to see that in the present. So we do our best with the evidence and a dash of intuition before everything is fully known.
The viral load piece just is meh for me. Lots of things reduce viral load (a point that Peter Palese pounded on me in a lovely conversation we had at NASEM last week). The reduction piece would be really nice...but I just don't see strong enough data for that. If that ends up being the case...that'd be great. If I knew for sure there were no harms, I'd say go for it. But I think we all know that we need to balance that. So I wait...
This came out yesterday.
Not good news for Paxlovid and Long Covid.
But other trials may still find something.
We will see.
https://www.medpagetoday.com/special-reports/exclusives/105295
Thank you for conducting and sharing this research. It sounds like the asthma/copd patients avoided negative outcomes whether or not they took Paxlovid --or was it that they experienced negative outcomes whether or not they took Paxlovid? Did you separate out asthma patients by subtype? I have read some research that suggests that some forms of asthma are protective while others are not. Are you or others planning to look at the efficacy of Paxlovid in those over 50 who are vaccinated broken down by pre-existing condition?
Congratulations on this much needed study. Were there any significant side effects from Paxlovid?
Please share more about what you are seeing in the ED related to Covid.
Are you wearing a mask?
We could not really study side effects per se.
I am indeed wearing a mask in the ER and in many public settings.
I'm seeing a lot less Covid but certainly it can hospitalize people with tenuous health and we do see that still.
A question, any findings either way for people who are immunocompromised due to taking immune suppressing biologic meds such as Enbrel which u packed their response to vaccination, including bivalent booster? Many thanks
Sorry we don't have that info! But I'd imagine it is very useful for this group. Can't prove it.
Thank you for replying! I continue to be a hermit as I do not wish to test the efficacy of my 6 doses of Pfizer while using Enbrel
This is great!
Do you have data on whether any of the patients were pregnant? (Of course as an OBGYN that’s the first thing I want to know, especially since pregnancy is generally a huge gap in the initial research on any drug.)
Congrats on the pub! I’m wondering if you have any thoughts on some of the other comorbidity subgroup analyses, e.g., BMI/obesity or diabetes? We heard a lot about those groups having poorer outcomes in the pre-vaccine era.
Perhaps the N of those subgroups was too low to analyze?
Well, it seems to support the original EUA issued by the FDA.
"PAXLOVID is a medicine that is available under EUA for the treatment of
mild-to-moderate COVID-19 in adults and children 12 years of age and older weighing
at least 88 pounds (40 kg) who are at high risk for progression to severe COVID-19,
including hospitalization or death. Although PAXLOVID is FDA-approved for the
treatment of COVID-19 in certain adults (see section What other treatment choices
are there?), PAXLOVID use in children remains investigational because it is still being
studied. There is limited information about the safety and effectiveness of using
PAXLOVID to treat children with mild-to-moderate COVID-19. "
Did your research looked into pediatric use of paxlovid?
We did not assess anyone under age 18. I would only consider it for extremely high risk kids.
Members of my family in their late 30/ early 40’s got Paxlovid last month. I understood why one did-- primary immune deficiency, but the other just had asthma. Metro Boston area. The person with the immune deficiency recovered slowly. Very timely and important information.
We all do bring our bias to health care-- receiving/providing and researching. I always share a great New Yorker article about how most studies can’t be replicated when someone is dogmatic about “evidence”.
Yeah and some studies can't ethically be repeated. So there's that. It's rarely as cut-and-dry as the extremists will tell you
Congratulations on pursuing this research and publishing 🙌
Thanks! I learned a lot.