Clinical Scorecard: Evaluating the Association Between Nirmatrelvir-Ritonavir Treatment for Acute COVID-19 and Post-COVID-19 Conditions in Adolescents and Adults: A Retrospective Cohort Analysis

At a Glance

Key Highlights

• Nirmatrelvir-ritonavir treatment reduced PCC risk in adults aged 50–64 years (aHR 0.93) and ≥65 years (aHR 0.88).
• Minimal effect on PCC risk was observed in high-risk adults aged 18–49 years (aHR 0.98) and no effect in high-risk adolescents aged 12–17 years (aHR 1.06).
• PCC was defined by ≥1 new-onset symptom or condition recorded ≥60 days after acute COVID-19, using a broad list of 45 ICD-10 codes.

Guideline-Based Recommendations

Diagnosis

• Identify COVID-19 cases via positive SARS-CoV-2 laboratory test, ICD-10 diagnosis code, or nirmatrelvir-ritonavir prescription within ±5 days of index date.
• Define PCC by presence of new symptoms or conditions ≥60 days post-COVID-19 using ICD-10 codes including U09.9.

Management

• Consider outpatient treatment with nirmatrelvir-ritonavir for mild to moderate COVID-19 in patients ≥50 years or with underlying risk factors to reduce risk of severe disease and PCC.
• Exclude patients with contraindications such as renal or liver disease or contraindicated medications from nirmatrelvir-ritonavir treatment.

Monitoring & Follow-up

• Monitor for new-onset symptoms or conditions consistent with PCC starting 60 days after acute COVID-19 diagnosis.
• Follow patients longitudinally through at least 60 days post-index date to assess for PCC development.

Risks

• Nirmatrelvir-ritonavir treatment showed no reduction in PCC risk among adolescents 12–17 years.
• Treatment is contraindicated in patients with renal or liver disease or those on contraindicated medications.

Patient & Prescribing Data

291,433 treated patients matched 1:2 with 582,866 untreated patients, all at higher risk for severe COVID-19.

Real-world data indicate nirmatrelvir-ritonavir reduces PCC risk in older adults but not in adolescents; treatment timing within ±5 days of diagnosis is critical.

Clinical Best Practices

• Use nirmatrelvir-ritonavir promptly within ±5 days of COVID-19 diagnosis in eligible high-risk patients to reduce PCC risk.
• Screen patients for contraindications before prescribing nirmatrelvir-ritonavir.
• Employ comprehensive ICD-10 coding to identify PCC symptoms and conditions for accurate diagnosis and surveillance.
• Prioritize treatment in adults ≥50 years given demonstrated protective effect against PCC.
• Continue research and surveillance to clarify PCC risk and treatment effects in younger populations.

References

• CDC HealthVerity Data Source
• Nirmatrelvir-ritonavir Authorization and Approval
• ICD-10 Code for Post-COVID-19 Condition (U09.9)