Why aren’t more doctors prescribing Paxlovid to COVID patients? Philly health advisory urges more use

Not enough doctors are prescribing an antiviral drug to treat COVID, Philadelphia’s health department said this month in a health advisory, adding that more widespread use of the drug can reduce hospitalizations and serious illness in high-risk patients.

Sold under the brand name Paxlovid, the antiviral medication makes it harder for COVID to replicate in a person’s body, decreasing a person’s risk of severe symptoms from the virus, said Shara Epstein, the medical director of the health department’s Division of Disease Control.

“The most important thing to know about Paxlovid is that is needs to be prescribed based on a person’s risk for severe disease, not based on current symptoms,” she wrote in an email.

But research suggests the treatment is underutilized, including among people who could benefit most from the drug. Patients at the highest risk for serious COVID complications were treated with antiviral drugs less often than people with a lower risk, a recent study in the Journal of the American Medical Association found, using 2022 data for seniors and other patients receiving coverage through the government-funded Medicare program.

Had more high-risk patients received such treatments, the study found, thousands of COVID deaths might have been prevented, researchers concluded.

That study, and others, also noted racial disparities among people prescribed COVID treatments, with white patients more likely to receive them than Black and Hispanic patients.

In Philadelphia, the health department doesn’t have specific information on how many people are prescribed Paxlovid, the brand name for ritonavir-boosted nirmatrelvir. Pennsylvania ranked in the middle of U.S. states for Paxlovid prescribing rates, according to a 2022 analysis by the U.S. Department of Health.

Epstein cited several reasons why Paxlovid might not be prescribed as often as it could be.

A person with COVID might not initially experience serious symptoms, and they or their doctor might want to try an antiviral medication only after they get worse, Epstein said. “But once disease is severe, Paxlovid won’t help,” she said.

Other doctors might balk at prescribing Paxlovid to patients who take other medications, because the drug can negatively interact with them. Most other medications can be paused while a patient takes Paxlovid, Epstein said.

Patients might also have concerns about a “viral rebound” after taking Paxlovid — a recurrence of COVID symptoms after an initial recovery. “Most studies show that there is not an increase in rebound after taking Paxlovid,” Epstein said, adding that people who do experience a COVID rebound don’t have severe symptoms.

Older adults, immunocompromised patients and other people with the highest risk of serious COVID complications should talk to their doctor about taking Paxlovid. Another option for treatment, the antiviral medication sold under the brand name Lagevrio, can also be prescribed for people who are not good candidate for Paxlovid treatment, she said.