A retrospective cohort study of Paxlovid efficacy depending on treatment time in hospitalized COVID-19 patients
- University of Hong Kong, Hong Kong
- University of Cambridge, United Kingdom
- Yale University, United States
- The University of Texas at Austin, United States
- University of Hong Kong, China
Abstract
Paxlovid, a SARS-CoV-2 antiviral, not only prevents severe illness but also curtails viral shedding, lowering transmission risks from treated patients. By fitting a mathematical model of within-host Omicron viral dynamics to electronic health records data from 208 hospitalized patients in Hong Kong, we estimate that Paxlovid can inhibit over 90% of viral replication. However, its effectiveness critically depends on the timing of treatment. If treatment is initiated three days after symptoms first appear, we estimate a 17% chance of a post-treatment viral rebound and a 12% (95% CI: 0%-16%) reduction in overall infectiousness for non-rebound cases. Earlier treatment significantly elevates the risk of rebound without further reducing infectiousness, whereas starting beyond five days reduces its efficacy in curbing peak viral shedding. Among the 104 patients who received Paxlovid, 62% began treatment within an optimal three-to-five-day day window after symptoms appeared. Our findings indicate that broader global access to Paxlovid, coupled with appropriately timed treatment, can mitigate the severity and transmission of SARS-Cov-2.
Data availability
All data used in this study can be accessed through Github: https://github.com/ZhanweiDU/PaxHK/.
Article and author information
Author details
Benjamin John Cowling
Funding
Innovation and Technology Commission (AIR@InnoHK)
- Zhanwei Du
Health and Medical Research Fund (07210147)
- Zhanwei Du
National Natural Science Foundation of China (82304204)
- Yuan Bai
National Institutes of Health (AI151176)
- Lauren A Meyers
Centers for Disease Control and Prevention (U01IP001136)
- Lauren A Meyers
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Ethics
Human subjects: Individual patient-informed consent was not required in this study using anonymized data.
Copyright
© 2024, Du et al.
This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.
Metrics
-
- 1,431
- views
-
- 204
- downloads
-
- 3
- citations
Views, downloads and citations are aggregated across all versions of this paper published by eLife.
Download links
A two-part list of links to download the article, or parts of the article, in various formats.
Downloads (link to download the article as PDF)
Open citations (links to open the citations from this article in various online reference manager services)
Cite this article (links to download the citations from this article in formats compatible with various reference manager tools)
A retrospective cohort study of Paxlovid efficacy depending on treatment time in hospitalized COVID-19 patients
eLife 13:e89801.
https://doi.org/10.7554/eLife.89801
