Does Paxlovid reduce the risk of long COVID?

Infectious Diseases Long COVID Treatments

Unfortunately, data is mixed on the usefulness of Paxlovid for the prevention of long COVID. We need more data, including clinical trials that are carefully designed, to evaluate whether or not there is a benefit.

Long COVID, also known as post-acute sequelae of COVID-19, refers to lingering symptoms that emerge in some individuals following a SARS-CoV-2 infection. Estimates of its frequency range from 2% to 25%, depending on the study. The symptoms of long COVID can severely impact patients, which highlights the increasing importance of understanding ways of preventing and treating it.

Paxlovid is an antiviral medication approved for treating SARS-CoV-2 infection in elderly people and those deemed at high risk for severe disease. While there was hope that Paxlovid would decrease the risk of long COVID, the data so far is mixed and has important limitations.

Paxlovid has been shown to reduce the risk of severe disease in high-risk people. This supports its benefit for this population, regardless of its impact on long COVID. Some studies have suggested that Paxlovid also reduces the risk of long COVID for this group. However, other studies indicate that while the overall incidence of long COVID remains similar, patients who took Paxlovid reported experiencing fewer cognitive symptoms, less fatigue, and a lower risk of blood clots following their SARS-CoV-2 infection.

The more challenging question is whether there’s a benefit to taking Paxlovid for people considered lower risk for severe disease, such as those who are vaccinated, younger, or without known pre-existing conditions. Only one study has focused on this population so far, and it did not find a reduced risk of developing long COVID. However, this study has significant limitations, including its inability to examine specific long COVID symptoms for potential improvements.

Why is the data so mixed?

Each of these studies was designed differently and relied on observations; we do not yet have a randomized trial looking at Paxlovid and long COVID. This makes it harder to compare the results from each study.

Long COVID is also difficult to study because there isn’t a straightforward method for diagnosing patients. Each patient presents a unique combination of symptoms, and diagnosis is made after ruling out other potential causes. Consequently, each study employs slightly different criteria for assessing long COVID development, leading to variability in the observed frequency and prevention of long COVID in each study.

Furthermore, there is increasing evidence suggesting that long COVID is an umbrella term encompassing numerous distinct post-viral complications, each likely triggered by SARS-CoV-2 through its own unique mechanism. This implies that we might eventually discover that Paxlovid helps reduce some causes of long COVID conditions but not others, which could explain why certain studies have reported a reduced risk of specific symptoms.

The news is not all bad. We have good data that COVID vaccines reduce the risk of long COVID even if one becomes infected.

But for Paxlovid and other treatments, we will need better-designed trials to assess the benefits of also using Paxlovid for this purpose. Until then, Paxlovid is still a great choice for reducing risk of COVID hospitalization and death for those at higher risk. Most drug-drug interactions for Paxlovid can be managed, so don’t hesitate to speak with your healthcare provider about your specific situation.