Safety and Efficacy of Paxlovid in COVID-19 Treatment: A Rapid Review

Mohammadreza Mobinizadeh; Ali Akbarisari; Alireza Olyaeemanesh; Marita Mohammadshahi; Elham Ahmadnezhad; Parisa Aboee; Zahra Gharib Naseri; Zeinab Fakoorfard; Raheleh Sadeghi

doi:10.18502/htaa.v6i1.11131

Mohammadreza Mobinizadeh National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.
Ali Akbarisari Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Alireza Olyaeemanesh National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.
Marita Mohammadshahi National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.
Elham Ahmadnezhad National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.
Parisa Aboee National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.
Zahra Gharib Naseri National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.
Zeinab Fakoorfard National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.
Raheleh Sadeghi National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/htaa.v6i1.11131

Keywords: Paxlovid; Rapid Review; COVID-19; Pandemic; Health Technology Assessment

Abstract

Context: In the first stage of viral replication, COVID-19 may cause a remarkable inflammatory response in patients. Paxlovid is an oral antivirus medicine that functions through the inhibition of one of the essential enzymes to viral replication, called protease. The present study intends to help policymakers decide on using Paxlovid in COVID-19 treatment.

Evidence Acquisition: This rapid review searched databases including Cochrane, PubMed, and Google Scholar by the end of July 2022. The inclusion criteria were randomized clinical trials investigating the safety and effectiveness of Paxlovid oral medicine at different doses in COVID-19 patients, compared with placebo or other routine care methods.

Results: Based on the results (from three studies meeting the inclusion criteria), Paxlovid has no serious side effects, but when used, the patients must be checked for renal and hepatic failure, as well as drug interactions. Patients treated with this medicine within five days after the symptom onset were hospitalized, with 1% (6/607) in the Paxlovid group and 6.7% (41/612) in the placebo group. Also, no fatalities were reported in the Paxlovid group until day 28, while 10 (1.6%) patients died in the placebo group.

Conclusions: Paxlovid is very effective in outpatient treatment and comes in a combination pack containing nirmatrelvir 150 mg and ritonavir 100 mg film-coated tablets, to be taken twice daily for five days after the symptom onset in adults and children (over 12 years old and a minimum weight of 40 kg) who have mild to moderate symptoms of COVID-19 in order to prevent severe disease, which may lead to hospitalization and death. However, there is high uncertainty about the possibility of drug interactions.