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

Background: Paxlovid use among high-risk community-dwelling U.S. adults has not been well characterized.

Objectives: To characterize Paxlovid use and evaluated racial/ethnic disparities over time among community-dwelling adults at high risk of progression to severe COVID-19 disease.

Methods: This 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 June 2023. The study cohort included non-hospitalized individuals who were at high risk of COVID-19 progression. We excluded individuals who had contraindications to Paxlovid, such as those with pregnancy, liver disease, hypersensitivity disorders and interacting medications. We selected the first COVID-19 episode in each quarter, including reinfection episodes. Paxlovid use was defined as the receipt of Paxlovid within ±5 days of a COVID-19 diagnosis. We used descriptive statistics to characterize Paxlovid use overall, by calendar quarter and race/ethnicity. We used logistic regression models to quantify the association of race/ethnicity with Paxlovid use controlling for sociodemographic (age, gender and race/ethnicity) and clinical characteristics (smoking status, comorbidities, vaccine status).

Results: Our study cohort included 708,124 individuals with COVID-19 (764,224 episodes). Overall, 21.1% of episodes were treated with Paxlovid, and the use was more common among individuals aged 61-80 years (25.4%) and non-Hispanic Whites (24.8%) than their counterparts. Although Paxlovid use increased from 1.5% from January-March 2022 to 34.3% in April-June 2023, nearly 2 out of 3 high-risk eligible patients with COVID-19 did not use Paxlovid in the most recent period. After adjusting all sociodemographic and clinical characteristics, Paxlovid use was less likely among non-Hispanic Blacks (odds ratio [OR] 0.62, 95% confidence interval [CI] 0.61-0.64) and Hispanics (OR 0.56, CI 0.54-0.57) than non-Hispanic Whites. In the adjusted analyses, the likelihood of receiving Paxlovid was consistently lower among non-Hispanic Blacks (OR ranges from 0.47 to 0.61) and Hispanics (OR ranges from 0.43 to 0.65) than non-Hispanic White in each calendar quarter during the study period.

Conclusions: Among a large, diverse cohort of community-dwelling individuals with COVID-19, nearly two out of three eligible individuals did not receive Paxlovid, and racial/ethnic minorities were less likely to use Paxlovid than non-Hispanic White. Our findings underscore the importance of clinical and policy initiatives to promote appropriate and equitable access to COVID-19 therapies and to optimize Paxlovid use.