December 2023
Do oral antivirals lower risk for long COVID in older adults?

Among older Medicare recipients, use of nirmatrelvir-ritonavir or molnupiravir was associated with modest reductions in long COVID.

Multiple considerations inform the decision to prescribe an oral antiviral (nirmatrelvir-ritonavir [Paxlovid] or molnupiravir) to reduce risk for severe COVID-19, and the most important risk factor – age – should help drive that decision. What about risk for post-COVID-19 conditions (PCC; defined as new occurrence of one of 11 symptoms between four and 12 weeks after COVID-19 diagnosis) in those aged 65 years and older?

In an observational study of oral antivirals and PCC, almost four million Medicare registrants with COVID-19 diagnoses between January and September 2022 were enrolled. After exclusions such as age below 65 years and inpatient admission, 57% remained. Of these participants, 19.5% received nirmatrelvir-ritonavir and 2.6% molnupiravir. Absolute risk reduction for PCC was 2.7% with nirmatrelvir-ritonavir and 0.8% with molnupiravir. At least one symptom of PCC occurred in 14.5% of untreated participants (fatigue, dyspnoea and cough were most common). Female sex and Asian, Black or Hispanic race as well as markers of low income were associated with increased risk for PCC.

Comment: PCC – commonly known as long COVID – remains a poorly understood but pernicious condition. This study shows that, among older adults, oral antivirals (particularly Paxlovid) are associated with modestly decreased risk for PCC. As these drugs are now in the private market and expensive, we will need as much evidence as possible to inform prescribing and payment decisions.

Daniel Kaul, MD, Professor of Medicine, Division of Infectious Diseases, Director, Transplant Infectious Disease Service, University of Michigan Medical School, Ann Arbor, USA.

Fung KW, et al. Nirmatrelvir and molnupiravir and post–COVID-19 condition in older patients. JAMA Intern Med 2023 Oct 23; e-pub (

This summary is taken from the following Journal Watch title: Infectious Diseases.

JAMA Intern Med