Hospitalization and Emergency Department Encounters for COVID-19 After Paxlovid Treatment — California, December 2021–May 2022

Details

• Corporate Authors:
  Centers for Disease Control and Prevention (U.S.)Epidemic Intelligence Service. ; Kaiser Permanente Department of Research & Evaluation. ; Kaiser Permanente Bernard J. Tyson School of Medicine. ; CDC COVID-19 Emergency Response Team. ; Harvard T.H. Chan School of Public Health. Center for Communicable Disease Dynamics. Department of Epidemiology. ; University of California, Berkeley. School of Public Health.
• Description:
  What is already known about this topic? Recurrence of COVID-19 symptoms and positive SARS-CoV-2 test results have been reported after completion of Paxlovid oral antiviral treatment for COVID-19, but real-world evidence of severe illness following Paxlovid is lacking.
  
  What is added by this report? COVID-19–related hospital admissions and emergency department (ED) encounters occurring 5–15 days after Paxlovid treatment were described using data from a large integrated health care system. Reports of such hospitalizations or ED encounters occurred infrequently, representing <1% of Paxlovid-treated patients over the study period.
  
  What are the implications for public health practice? When administered as an early-stage treatment, Paxlovid might prevent COVID-19–related hospitalization among persons with mild-to-moderate COVID-19 who are at risk for progression to severe disease.
  
  Nirmatrelvir/ritonavir (Paxlovid) is a combination protease inhibitor that blocks replication of SARS-CoV-2 (the Virus that causes COVID-19) and has been shown to reduce the risk for hospitalization and death among patients with mild to moderate COVID-19 who are at risk for progression to severe disease* (1). In December 2021, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for early treatment with Paxlovid among persons with mild to moderate cases of COVID-19 who are at high risk for progression to severe disease (2). FDA and a small number of published case reports have documented recurrence of COVID-19 symptoms or a positive viral test result (COVID-19 rebound) 2–8 days after recovery or a negative SARS-CoV-2 test result among patients treated with Paxlovid (3–7); however, large-scale studies investigating severe illness after Paxlovid treatment are limited. This study used electronic health record (EHR) data from a large integrated health care system in California (Kaiser Permanente Southern California [KPSC]) to describe hospital admissions and emergency department (ED) encounters related to SARS-CoV-2 infections during the 5–15 days after pharmacy dispensation of a 5-day treatment course of Paxlovid. Among 5,287 persons aged ≥12 years who received Paxlovid during December 31, 2021–May 26, 2022, 73% had received ≥3 doses of COVID-19 vaccine†, and 8% were unvaccinated. During the 5–15 days after Paxlovid treatment was dispensed, six hospitalizations and 39 ED encounters considered to be related to SARS-CoV-2 infection were identified, representing <1% of all patients to whom Paxlovid treatment was dispensed during the study period. Among these 45 persons, 21 (47%) were aged ≥65 years, and 35 (78%) had at least one underlying medical condition§ (8). This study found that hospitalization or ED encounters for COVID-19 during the 5–15 days after Paxlovid treatment was dispensed for mild to moderate COVID-19 illness were rarely identified. When administered as an early-stage treatment, Paxlovid might prevent COVID-19–related hospitalization among persons with mild to moderate cases of COVID-19 who are at risk for progression to severe disease.
  
  Suggested citation for this article: Malden DE, Hong V, Lewin BJ, et al. Hospitalization and Emergency Department Encounters for COVID-19 After Paxlovid Treatment — California, December 2021–May 2022. MMWR Morb Mortal Wkly Rep. ePub: 21 June 2022
  
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• Subjects:
  Antiviral Agents COVID-19/Drug Therapy Drug Combinations/Therapeutic Use Emergency Service, Hospital Hospitalization Nirmatrelvir And Ritonavir Drug Combination/Therapeutic Use
• Source:
  MMWR: Morbidity and Mortality Weekly Report 2022; v. 71 Early Release
• Series:
  Weekly Report: Morbidity and Mortality Weekly Report (MMWR)
• ISSN:
  0149-2195 (print) ; 1545-861X (digital)
• Document Type:
  Journal Article
• Place as Subject:
  California
• Pages in Document:
  5 pdf pages
• Volume:
  71
• Collection(s):
  Morbidity and Mortality Weekly Report (MMWR)
• Main Document Checksum:
  urn:sha-512:9ece2457073af0ca64d3687552acfc5df8cbf3df539d7a622526c6dee51c7229bafc03111bf78375587b3ff45ecb021466e69f4659a8edd28f940fd69b7ce509
• Download URL:
  https://stacks.cdc.gov/view/cdc/118440/cdc_118440_DS1.pdf
• File Type:
  [PDF - 209.40 KB ]