Paxlovid reduces risk of long Covid, Veterans Affairs study finds

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Paxlovid, the antiviral pill that reduces the risk of hospitalization and death from Covid-19, also reduces the risk of long Covid, according to a new study by researchers at the US Department of Veterans Affairs.

The study, posted online as a preprint on Saturday, analyzed electronic records for more than 56,000 veterans with Covid-19, including more than 9,000 who were treated with Paxlovid within the first five days of their infection.

The analysis showed people treated with Paxlovid had a 26% reduced risk of developing several long Covid conditions, including heart disease, blood disorders, fatigue, liver disease, kidney disease, muscle pain, neurocognitive impairment and shortness of breath. That corresponded to 2.3 fewer cases of long Covid conditions per 100 people three months after their diagnosis. Paxlovid also reduced the risk of hospitalization or death following acute Covid-19.

In the analysis, there wasn’t a statistically significant link between taking Paxlovid and risk of two long Covid conditions: cough and new diabetes diagnosis.

The study was posted to the preprint server medRxiv and hasn’t been peer-reviewed or published in a medical journal.

Patients included in the study had an average age of 65 and were diagnosed with Covid-19 between March 1 and June 30, 2022. They all had at least one risk factor for progression to severe Covid-19, such as older age, diabetes or being a current smoker. Paxlovid reduced the risk of long Covid in people who were unvaccinated, vaccinated and boosted, and in people experiencing their first Covid-19 infection or a reinfection, the study said.

“Paxlovid reduces the risk of severe COVID-19 in the acute phase, and now, we have evidence that it can help reduce the risk of long COVID,” Dr. Ziyad Al-Aly, chief of research and development at the VA St. Louis Health Care System and leader of the study, said in a news release. “This treatment could be an important asset to address the serious issue of long COVID.”

The study has several limitations, including that the majority of people included were White and male, which might limit its relevance more generally. The analysis captured Paxlovid use only through the VA system and considered only 12 long Covid conditions, although many people with long Covid describe a wide variety of symptoms.

Millions of people who had Covid-19 face a range of lasting symptoms since their initial illness, but there is no specific treatment for long Covid. Paxlovid is an antiviral treatment for Covid-19 that combines a newer antiviral, nirmatrelvir, with an older drug, ritonavir. It’s available for people as young as 12 and has been shown to sharply reduce risk of hospitalization and death in people at risk of severe Covid-19.

The drug is made by Pfizer and comes as pills taken over five days. It works best if started within five days of symptom onset; researchers noted it’s not clear whether longer duration or higher dose or both might reduce risk of long Covid conditions even more, or whether starting Paxlovid after acute illness from Covid-19 would reduce risk of long Covid. The National Institutes of Health said last month it would launch a study of Paxlovid as a treatment for patients already experiencing long Covid.

“The totality of evidence suggests the need to improve uptake and utilization of nirmatrelvir in the acute phase as a means of not only preventing progression to severe acute disease, but to also reduce the risk of post-acute adverse health outcomes,” authors of the VA study wrote.

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