Choosing Paxlovid Wisely - Limited Evidence To Support Ontario's Dec 2022 Paxlovid Criteria

On December 8, 2022, Ontario expanded the eligibility criteria for Paxlovid (nirmatrelvir/ritonavir) therapy to a larger population of patients and increased accessibility to this oral antiviral drug by allowing community pharmacists to prescribe Paxlovid. Although this is fantastic in terms of public accessibility to this treatment, do the evidence support this expansion in criteria?

In this video, I summarize the best available evidence and give my impression on whether the evidence is strong enough to support giving Paxlovid to everyone recommended in the December 2022 Ontario guidance.

I last conducted my literature review on March 4, 2023.

Thankyou so much for your support 💕

-----
**If you'd like to help support my channel, you may do so simply by buying me a coffee 💕:
https://ko-fi.com/shsieh_rx
-----
Partnership: [email protected]
------

References of the studies mentioned in the video:

1. Shah MM, Joyce B, Plumb ID, et al. Paxlovid Associated with Decreased Hospitalization Rate Among Adults with COVID-19 — United States, April–September 2022. MMWR Morb Mortal Wkly Rep 2022;71:1531–1537. DOI: http://dx.doi.org/10.15585/mmwr.mm7148e2

2. Najjar-Debbiny R, Gronich N, Weber  G, Khoury J, Amar M, Stein N, et al. Effectiveness of Paxlovid in Reducing Severe Coronavirus Disease 2019 and Mortality in High-Risk Patients. Clin Infect Dis. 2023 Feb 8;76(3):e342-e349. doi: 10.1093/cid/ciac443. 

3. Arbel R, Sagy YW, Hoshen M, Battat E, Lavie G, Sergienko R, et al. Nirmatrelvir Use and Severe Covid-19 Outcomes during the Omicron Surge. N Engl J Med. 2022 Sep 1;387(9):790-798. doi: 10.1056/NEJMoa2204919.

4. Aggarwal NR, Molina KC, Beaty LE, Bennett TD, Carlson NE, Mayer DA, et al. Real-world use of nirmatrelvir-ritonavir in outpatients with COVID-19 during the era of omicron variants including BA.4 and BA.5 in Colorado, USA: a retrospective cohort study. Lancet Infect Dis. 2023 Feb 10;S1473-3099(23)00011-7. doi: 10.1016/S1473-3099(23)00011-7.

5. Wong CKH, Au ICH, Lau KTK, Lau EHY, Cowling BJ, Leung GM. Real-world effectiveness of molnupiravir and nirmatrelvir plus ritonavir against mortality, hospitalisation, and in-hospital outcomes among community-dwelling, ambulatory patients with confirmed SARS-CoV-2 infection during the omicron wave in Hong Kong: an observational study. Lancet. 2022 Oct 8;400(10359):1213-1222. doi: 10.1016/S0140-6736(22)01586-0.

6. Schwartz KL, Wang J, Tadrous M, Langford BJ, Daneman N, Leung V, et al. Population-based evaluation of the effectiveness of nirmatrelvir-ritonavir for reducing hospital admissions and mortality from COVID-19. CMAJ. 2023 Feb 13;195(6):E220-E226. doi: 10.1503/cmaj.221608.

7. Weiss G. Who should receive oral antiviral therapy for severe acute respiratory syndrome coronavirus 2 infection in the omicron era? Choose wisely. Clin Microbiol Infect. 2023 Mar; 29(3): 281–283.

Disclaimer: The information in this video represents my opinion only. Please use your clinical judgement before applying the information presented in this video to your patients as every patient scenario is different. Medical evidence also evolves quickly and the evidence presented in this video may be outdated by the time it is published. Before using the information presented in this video to your practice, ALWAYS check the original references and conduct a literature search to see if there are updates to the recommendations based on new evidence. I do not accept responsibility for any harms from the use of the information in this video to make medical decisions. This video constitutes my own thought process and views, and do not reflect those of my employer, organization, committee, or other group or individual.