A retrospective cohort study of Paxlovid efficacy depending on treatment time in hospitalized COVID-19 patients

Author:

Du Zhanwei12ORCID,Wang Lin3ORCID,Bai Yuan12,Liu Yunhu1,Lau Eric HY124,Galvani Alison P4,Krug Robert M5ORCID,Cowling Benjamin John12ORCID,Meyers Lauren A67ORCID

Affiliation:

1. WHO Collaborating Center for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region

2. Laboratory of Data Discovery for Health Limited

3. Department of Genetics, University of Cambridge

4. Center for Infectious Disease Modeling and Analysis, Yale School of Public Health

5. Department of Molecular Biosciences, John Ring LaMontagne Center for Infectious Disease Institute for Cellular and Molecular Biology, University of Texas at Austin

6. Department of Integrative Biology, University of Texas at Austin

7. Santa Fe Institute

Abstract

Paxlovid, a SARS-CoV-2 antiviral, not only prevents severe illness but also curtails viral shedding, lowering transmission risks from treated patients. By fitting a mathematical model of within-host Omicron viral dynamics to electronic health records data from 208 hospitalized patients in Hong Kong, we estimate that Paxlovid can inhibit over 90% of viral replication. However, its effectiveness critically depends on the timing of treatment. If treatment is initiated three days after symptoms first appear, we estimate a 17% chance of a post-treatment viral rebound and a 12% (95% CI: 0–16%) reduction in overall infectiousness for non-rebound cases. Earlier treatment significantly elevates the risk of rebound without further reducing infectiousness, whereas starting beyond five days reduces its efficacy in curbing peak viral shedding. Among the 104 patients who received Paxlovid, 62% began treatment within an optimal three-to-five-day day window after symptoms appeared. Our findings indicate that broader global access to Paxlovid, coupled with appropriately timed treatment, can mitigate the severity and transmission of SARS-Cov-2.

Funder

Innovation and Technology Commission - Hong Kong

Health and Medical Research Fund

National Natural Science Foundation of China

National Institutes of Health

Centers for Disease Control and Prevention

Publisher

eLife Sciences Publications, Ltd

Reference43 articles.

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