Early data: Paxlovid may help ward off long COVID
Long COVID, a wide-ranging set of sometimes debilitating symptoms following a COVID infection, is a pressing and worrisome challenge for both patients and medical researchers, who are racing to figure out how to both prevent and treat the disease.
Some evidence has emerged that Paxlovid, an oral antiviral medication used to treat COVID-19, can help reduce the risk of ending up with long COVID, experts said — and it’s one more reason to seek the treatment.
Dr. Bob Wachter, UCSF’s chair of medicine, said in an email that the evidence, which comes from a study out of the Department of Veterans Affairs, isn’t huge, but shows Paxlovid can make “a meaningful difference” in warding off long COVID. It’s one of the reasons he’d take Paxlovid if he had COVID, he said.
The November 2022 study of 56,000 people with COVID found that the more than 9,000 who took Paxlovid in the first five days of their infection had a 25 percent lower risk of long COVID symptoms, including heart disease, blood disorders, fatigue, liver disease, kidney disease, muscle pain, neurocognitive impairment and shortness of breath.
In an interview with Wachter live streamed Thursday for the UCSF medical school’s grand rounds series, Dr. Eric Topol, director of the Scripps Research Translational Institute and a leading voice on COVID, agreed with Wachter, saying even the chance that Paxlovid helps prevent long COVID or reduce its severity is one of the main reasons to take the drug early.
But the data from one study isn’t conclusive. In last month’s grand rounds, White House COVID-19 Response Director Dr. Ashish Jha told Wachter that data showing therapies like Paxlovid can reduce risk of long COVID are “very suggestive” and “very observational.”
“I wouldn’t bank on it,” he said, though he noted that “clinically it makes some sense.”
Dr. Peter Chin-Hong, an infectious disease doctor at UCSF, noted that the VA study was the only published research on Paxlovid and long COVID he knew of, but that its results “make a lot of sense” to him.
Much more research needs to be done, the experts said, noting that long COVID takes a variety of forms.
Jha said that what people call long COVID is a “heterogeneous” set of problems — some arising from persistent virus in the bloodstream, some from immune dysfunction, and some from tissue damage during COVID.
“It isn’t one condition,” he said. Because of that, he added, ongoing trials for how to treat and prevent it will likely have to target specific causes to come up with effective approaches.
And Topol said he thinks the medical community is behind in finding treatments that reliably work for any kind of long COVID.
“We’ve left these (people with long COVID) in the lurch,” he said. “We haven’t come with anything to help treat it.”
Some studies to address long COVID are in motion. Stanford, for example, recently started looking for candidates for a clinical trial to see if Paxlovid can actually treat long COVID once people already have it.
In the meantime, the experts said, there is much more substantial evidence that vaccination reduces the risk of long COVID. A recent review of research in the British Medical Journal, for example, found that the up-to-date body of evidence supports that COVID vaccination reduces the likelihood, severity and duration and long COVID.
“We have very good data, I would argue, that the more up to date you are on your vaccines, the lower your risk,” Jha told Wachter. “It doesn’t go to zero but it clearly drives it lower.”
Both Paxlovid and vaccines “look like they’re helping to prevent long COVID,” Topol said. “It’s the treatment side that needs more.”