Nirmatrelvir/Ritonavir (Paxlovid) Use Among Individuals at Risk of Severe COVID‐19: An Analysis of the National COVID Cohort Collaborative (N3C)

Abstract

ABSTRACTPurposePaxlovid is effective in reducing COVID‐19 hospitalization and mortality. This study characterized Paxlovid use and evaluated racial/ethnic disparities over time among community‐dwelling adults at high risk of progression to severe COVID‐19 disease.MethodsThis retrospective cohort study used the National COVID Cohort Collaborative (N3C) data and included individuals aged 18 years or older diagnosed with COVID‐19 between January 2022 and December 2023. The study cohort included nonhospitalized individuals who were at high risk of COVID‐19 progression, and selected the first COVID‐19 episode in each quarter, including reinfection episodes. Paxlovid use was defined as receiving Paxlovid within ±5 days of a COVID‐19 diagnosis. We used descriptive statistics to characterize Paxlovid use overall and by calendar quarter and race/ethnicity. We used a generalized estimating equations (GEE) models to quantify the association of race/ethnicity with Paxlovid use controlling for age, gender, and clinical characteristics.ResultsAmong 1 264 215 individuals at high risk of disease progression (1 404 607 episodes), Paxlovid use increased from 1.2% in January–March 2022 to 35.1% in October–December 2023. Paxlovid use was more common among non‐Hispanic White individuals (23.9%) than non‐Hispanic Black (16.5%) and Latinx/e (16.7%) patients. After adjusting age, gender, and clinical characteristics, Paxlovid use was less likely among non‐Hispanic Black (odds ratio [OR] 0.69, 95% confidence interval [CI] 0.68–0.70) and Latinx/e (OR 0.72, CI 0.71–0.73) patients than non‐Hispanic White patients.ConclusionsAmong a large, diverse cohort of community‐dwelling individuals with COVID‐19, nearly two out of three eligible individuals did not receive Paxlovid, and minoritized racial/ethnic groups were less likely to use Paxlovid than their non‐Hispanic White individuals.