Hospitalizations and Mortality Among Older Adults With and Without Restricted Access to Nirmatrelvir-Ritonavir, 2025, Mafi et al

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Hospitalizations and Mortality Among Older Adults With and Without Restricted Access to Nirmatrelvir-Ritonavir

John N. Mafi, Sitaram Vangala, Moira K. Kapral, Peter E. Wu, Manying Cui, Artem Romanov, Katherine L. Kahn

Abstract
Randomized clinical trials of nirmatrelvir-ritonavir found reduced COVID-19–related hospitalizations among unvaccinated patients but not vaccinated patients. Although advanced age is the strongest predictor of severe COVID-19, the median ages of the trial participants were 42 and 46 years. It remains unknown whether the results of these trials generalize to older and highly vaccinated populations. We made use of a natural experiment to compare hospitalization and mortality outcomes in vaccinated older adults with vs without restricted access to nirmatrelvir-ritonavir.

Link (JAMA) [Paywall]

 

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Science: 'Paxlovid: You'd Have Expected More'

The authors are taking advantage of a "natural experiment" situation in Ontario. Between April and December of 2022, the province reserved Paxlovid treatment for symptomatic adults aged 70 or older, with exceptions for the immunocompromised or were incompletely vaccinated along with at least one other risk factor. The authors examined data for ther 65-69 year old cohort along with the 70-74 year olds across this discontinuity, looking for effects.

But there were no significant differences in the below-70 cohort versus the above-70 one in Covid-related hospitalizations, all-cause hospitalizations, or all-cause mortality. And looking back to 2021, before Paxlovid became available at all, there were no significant differences between those groups then, either. So from these data (which are surely among the best we have) it appears that in vaccinated adults (without reference to any high-risk subgroups) that Paxlovid is not making much of a difference at all!

The other way to interpret this is that the vaccinations themselves have done enough to help keep people out of the hospital that Paxlovid treatment can't do much more.