Close up of the antiviral by Pfizer, Paxlovid.
Image credits: Unsplash
A recent study published in Open Forum Infectious Diseases demonstrates that nirmatrelvir-ritonavir (Paxlovid), an antiviral treatment for COVID-19, significantly reduces short- and long-term adverse outcomes in patients with kidney disease. This cohort study involved 1,095 patients with kidney disease who received Paxlovid, compared to 584 patients diagnosed with COVID-19 before the treatment’s introduction.1
The results revealed that Paxlovid-treated patients were 56% less likely to be hospitalized within 30 days of diagnosis (adjusted subdistribution hazard ratio (sHR) .44, p<.01). Additionally, at one year, these patients had a significantly lower risk of hospitalization due to major adverse cardiovascular events (MACE) (adjusted sHR .49, p<.01) and death (adjusted hazard ratio (aHR) .37, p<.01). Although, the treatment did not show an impact on the progression of chronic kidney disease (CKD) or the rate of eGFR decline over the year following infection.1
This study underscores the potential benefits of Paxlovid in reducing hospitalizations and mortality in patients with CKD and kidney failure, though it does not prevent CKD progression. These findings highlight the need for continued research into the optimal management of COVID-19 in this vulnerable population.1
What You Need To Know
Paxlovid significantly reduces hospitalization and mortality rates in patients with kidney disease, lowering the risk of hospitalization by 56% within 30 days and decreasing death and major adverse cardiovascular events (MACE) at one year.
The treatment does not impact the progression of chronic kidney disease (CKD) or the rate of eGFR decline over the year following infection.
These findings emphasize the need for further research into personalized treatment strategies for high-risk populations, particularly those with kidney disease.
These findings are aligned with results from the EPIC-HR trial, which assessed the efficacy of Paxlovid in high-risk individuals with pre-existing immunity (from prior COVID-19 infection or vaccination). In a recent analysis of the EPIC-HR trial, we spoke with Pzifer. The researcher found that Paxlovid still provided significant benefits in preventing hospitalization and death in high-risk patients, even in the context of pre-existing immunity. Specifically, Paxlovid was shown to reduce the risk of hospitalization and death by 73.7% compared to a placebo. It also led to faster symptom resolution and reduced the incidence of severe symptoms.2
The similarities between these two studies are notable. Both highlight Paxlovid’s effectiveness in reducing severe COVID-19 outcomes in high-risk populations—whether they are individuals with chronic kidney disease or those with pre-existing immunity from vaccination or prior infection. Both studies emphasize that Paxlovid is still beneficial for high-risk patients, though in the kidney disease study, it did not prevent CKD progression, unlike in the broader high-risk population examined in the EPIC-HR analysis.2
Thus, while both studies confirm that Paxlovid is an important therapeutic tool for mitigating severe COVID-19 outcomes in vulnerable populations, they also highlight the need for additional research into how the treatment can affect long-term kidney function and its impact in immunocompromised groups with complex co-morbidities.
Overall, these studies demonstrate the ongoing utility of Paxlovid in the management of COVID-19 in high-risk patients, but also point to the necessity of personalized treatment strategies based on underlying health conditions such as kidney disease and pre-existing immunity.
