At-risk patients often not offered antivirals for COVID-19, analysis shows – University of Minnesota Twin Cities

Four out of five Veterans Affairs (VA) patients who had mild COVID-19 but had compromised immune systems were not offered the use of COVID antivirals, according to a study today in Morbidity and Mortality Weekly Report.

The study, though small, illustrates the reluctance of providers to prescribe antivirals, including Paxlovid, to patients who present with mild illness, but are at risk of progressing to severe disease.

Currently in the United States, anyone age 12 and older at risk for severe progression of disease is eligible for antiviral use at the first sign of a COVID-19 diagnosis. The antiviral drugs nirmatrelvir/ritonavir (Paxlovid) and remdesivir (Veklury) are approved by the Food and Drug Administration, and molnupiravir (Lagevrio) is authorized for emergency use.

When used within 5 days of symptom development, antivirals can reduce the severity and duration of the disease. But currently reported antiviral use among the general adult population has been 35% or less.

In today's study, VA researchers reviewed 110 VA patients who were at risk for severe COVID-19 (mostly due to organ transplantation or hematologic malignancies) but did not receive an antiviral. All patients were seen between from 1, 2022 (when effective oral antivirals became widely available to treat outpatients with mild-to-moderate COVID-19) through September 30, 2022.

Among the patients, all of whom were vaccinated against COVID-19, 22 (20.0%) were offered treatment but declined, and 88 (80.0%) were not offered treatment.

Of those not offered antiviral treatment, provider reasons included symptom duration of more than 5 days (22.7%), concern about possible drug interactions (5.7%), or absence of symptoms (22.7%). For almost one half (43 of 88; 48.9%) of these patients, no reason for not offering antivirals was given other than mild symptoms. No providers mentioned Paxlovid reboundwhich might not be caused by the drug at allas a reason to not prescribe.

"These findings suggest that education of patients, providers, and medical personnel tasked with follow-up calls, combined with advance planning in the event of a positive test result, might improve the rate of recommended antiviral medication use to prevent severe COVID-19associated illness, including death," the authors concluded.

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At-risk patients often not offered antivirals for COVID-19, analysis shows - University of Minnesota Twin Cities