Paxlovid in patients who are immunocompromised and hospitalised with SARS-CoV-2 infection

Overall, 114 symptomatic patients who were hospitalised with SARS-CoV-2, with a mean age of 65·87 years, a high comorbidity rate (79%), and a low vaccination rate (26·5%) received paxlovid therapy. Three patients died within 28 days; all with a prolonged viral elimination. One patient died of respiratory failure attributed to SARS-CoV-2 infection, the other two patients died of deterioration of underlying comorbidities (appendix p 2).

Next, we did univariate and binary logistic regression to identify risk factors of prolonged viral elimination among our registry cohort. No vaccination, delayed paxlovid treatment (>5 days after diagnosis), and immunocompromised condition were independent predictors for prolonged viral elimination (appendix p 3).

There were 35 patients who were immunocompromised in our cohort, including three recipients of solid organ transplants, seven with autoimmune rheumatic conditions, three with haematological malignancies, and 22 with malignant solid tumours. Their viral elimination time was much longer than for patients who were not immunocompromised (17·29 days [6·35] vs 14·08 days [5·92], p=0·0050; appendix pp 4,5). Of note, paxlovid prescription within 5 days of diagnosis had a faster clearance of viral load as measured by ORF1ab viral gene replication (appendix p 3) and a shorter time to viral elimination in patients who are immunocompromised (13·67 days [5·84] vs 19·17 days [5·87], p=0·022; appendix pp 6,7). In addition, the correlation between timing of paxlovid initiation and viral elimination is linear (appendix p 3).

In summary, this real-life study in Chinese patients with SARS-CoV-2 infection called for action to implement early treatment of paxlovid for high-risk patients who are immunocompromised,

including those who are hospitalised, and unvaccinated in particular, in order to facilitate viral eradication.