Oral COVID-19 antiviral uptake among a highly vaccinated U.S. cohort of adults with SARS-CoV-2 infection between December 2021 and October 2022

Abstract

Abstract Background We described the oral nirmatrelvir/ritonavir (NMV/r) and molnupiravir (MOV) uptake among the sub-group of highly vaccinated adults in a U.S. national prospective cohort who were infected with SARS-CoV-2 between 12/2021 and 10/2022. Methods We estimate antiviral uptake within 5 days of SARS-CoV-2 infection, as well as age- and gender- adjusted antiviral uptake prevalence ratios by antiviral eligibility (based on age and comorbidities), sociodemographic, and clinical characteristics including vaccination status and history of long COVID. Results NMV/r uptake was 13.6% (95% CI: 11.9% – 15.2%) among 1,594 participants and MOV uptake was 1.4% (95% CI: 0.8% – 2.1%) among 1,398 participants. NMV/r uptake increased over time (1.9% [95% CI: 1.0% – 2.9%] between 12/2021-3/2022, 16.5% [95% CI: 13.0% – 20.0%] between 4/2022-7/2022, and 25.3% [95% CI: 21.6% – 29.0%] between 8/2022-10/2022). Participants age ≥65 and those who had comorbidities for severe COVID-19 had higher NMV/r uptake. There was lower NMV/r uptake among non-Hispanic Black participants (7.2% [95% CI: 2.4% – 12.0%]) (relative to other racial/ethnic groups) and among individuals in the lowest income groups (10.6% [95% CI: 7.3% – 13.8%]) (relative to higher income groups). Among a subset of 278 participants with SARS-CoV-2 infection after 12/2021 who also had a history of prior SARS-CoV-2 infection, those with (versus without) a history of long COVID reported greater NMV/r uptake (22.0% vs. 7.9%; P = 0.001). Among those prescribed NMV/r (n = 216), 137 (63% [95% CI: 57% - 70%]) reported that NMV/r was helpful for reducing COVID-19 symptoms. Conclusions Despite proven effectiveness against severe outcomes, COVID-19 antiviral uptake remains low among those with SARS-CoV-2 infection in the U.S. Further outreach to providers and patients to improve awareness of COVID-19 oral antivirals and indications is needed.