Risk Factors for Seeking Medical Care Following Nirmatrelvir-Ritonavir (Paxlovid) Treatment for COVID-19: “Symptom Rebound”.

Publication date: May 29, 2025

Nirmatrelvir plus ritonavir (NPR) has been approved for treating mild to moderate COVID-19 in high-risk adults but concerns about rebound effects have limited its use. This study aimed to identify individuals at risk of seeking medical care among high-risk non-hospitalized patients treated with NPR from 1 January 2022 to 31 December 2022, at our institution. Our outcome variable was the composite of subsequent evaluation in the Emergency Department or inpatient admission within four weeks of their NPR treatment. Of 369 patients who received NPR treatment, the mean (SD) age was 59. 3 (+/-13. 8) years; 64% (236) were female, and 77. 7% (281) were white. The incidence of the composite event was 6. 8% (25/369). In multivariable logistic regression, factors for seeking medical care following NPR treatment were female sex (OR 4. 6; 95% CI 1. 4-15. 3; p = 0. 013), myocardial infarction (OR 4. 1; 95% CI 1. 4-11. 8; p = 0. 011), chronic lung disease (CLD) except asthma and chronic obstructive pulmonary disease (COPD) (OR = 3. 9, 95% CI 1. 1-13. 5; p = 0. 03), and diabetes mellitus with complications (OR 6. 9; 95% CI 2. 0-23. 3; p = 0. 002) while alcohol users (OR 0. 39; 95% CI 0. 2-0. 9; p = 0. 038) were less likely to seek medical care. Larger cohorts are necessary to further assess and confirm these risk factors.

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Concepts Keywords
Diabetes Adult
Female Aged
Inpatient Antiviral Agents
Npr Antiviral Agents
COVID-19
COVID-19
COVID-19 Drug Treatment
Female
Humans
Male
Middle Aged
nirmatrelvir–ritonavir
Paxlovid
predictors
Risk Factors
risk factors
Ritonavir
Ritonavir
SARS-CoV-2

Semantics

Type Source Name
drug DRUGBANK Ritonavir
disease MESH COVID-19
disease IDO symptom
disease MESH Emergency
disease MESH myocardial infarction
disease MESH lung disease
disease MESH asthma
pathway KEGG Asthma
disease MESH chronic obstructive pulmonary disease
disease MESH diabetes mellitus
disease MESH complications
drug DRUGBANK Ethanol
disease MESH diabetes mellitus complications
disease MESH death
disease MESH recurrence
disease IDO assay
disease MESH neutropenia
drug DRUGBANK Prednisone
disease IDO history
disease MESH hypertension
disease MESH obesity
disease MESH malignancy
disease IDO immunosuppression
disease MESH chest pain
disease MESH sore throat
disease MESH bleeding
disease MESH Substance abuse
disease MESH Congestive heart failure

Original Article

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