NEJM Journal Watch
Paul S. Mueller, MD, MPH, FACP, reviewing
COVID-19 vaccination and receiving nirmatrelvir within 5 days of a positive SARS-CoV-2 test lowered risk for long COVID.
Vaccination and antiviral treatment with nirmatrelvir (a component of Paxlovid) lower risks for hospitalization and death due to COVID-19 (NEJM JW Infect Dis Jun 2022 and BMJ 2022; 377:69317; NEJM JW Gen Med Oct 1 2022 and N Engl J Med 2022; 387:790). Do vaccination and nirmatrelvir prevent post–COVID-19 condition (“long COVID”)? Two recent reports provide some answers to this question.
In a meta-analysis of 41 studies that involved 861,000 patients, researchers identified demographic and other factors associated with significant excess risk for long COVID in adults: female sex; older age; body-mass index (BMI), ≥30 kg/m2; current smoking; comorbidities (e.g., asthma, diabetes, heart disease, immunosuppression); and previous hospitalization for COVID-19. In contrast, prior two-dose vaccination for COVID-19 was associated with significantly lower risk for long COVID (by 43%).
A cohort study involved 282,000 U.S. Veterans Affairs patients (mean age, 62) who had positive SARS-CoV-2 test results and one risk factor for progression to severe COVID-19 (e.g., age >60; high BMI; current smoker; or various comorbidities). The 13% of patients who received nirmatrelvir within 5 days after a positive test result had significantly lower risk for long COVID (by 26%) and lower risks for postacute hospitalization and death. Nirmatrelvir was associated with lower risk for long COVID in people who were unvaccinated, vaccinated, or boosted and in people with either primary infections or reinfections.
CITATIONS
Tsampasian V et al. Risk factors associated with post−COVID-19 condition: A systematic review and meta-analysis. JAMA Intern Med 2023 Mar 23; [e-pub]. (https://doi.org/10.1001/jamainternmed.2023.0750)
Xie Y et al. Association of treatment with nirmatrelvir and the risk of post–COVID-19 condition. JAMA Intern Med 2023 Mar 23; [e-pub]. (https://doi.org/10.1001/jamainternmed.2023.0743)
Katz MH. While waiting for a randomized clinical trial of nirmatrelvir for prevention of post–COVID-19 condition. JAMA Intern Med 2023 Mar 23; [e-pub]. (https://doi.org/10.1001/jamainternmed.2023.0760)
COMMENT
These reports provide compelling evidence that COVID-19 vaccination and early treatment of COVID-19 with nirmatrelvir (regardless of vaccine or infection status) are associated with lower risk for long COVID. Along with these interventions, a healthy lifestyle (e.g., not smoking, regular physical activity) also lowers risk for long COVID (NEJM JW Gen Med Mar 15 2023 and JAMA Intern Med 2023; 183:232).