Oral COVID-19 Antiviral Uptake Among a Highly Vaccinated US Cohort of Adults With SARS-CoV-2 Infection Between December 2021 and October 2022

Yanhan Shen; McKaylee M Robertson; Sarah G Kulkarni; Laura Puzniak; Joann M Zamparo; Kristen E Allen; Thomas M Porter; Saba A Qasmieh; Christian Grov; Avantika Srivastava; Rebecca Zimba; John M McLaughlin; Denis Nash

doi:10.1093/ofid/ofad674

Oral COVID-19 Antiviral Uptake Among a Highly Vaccinated US Cohort of Adults With SARS-CoV-2 Infection Between December 2021 and October 2022

Open Forum Infect Dis. 2023 Dec 21;11(2):ofad674. doi: 10.1093/ofid/ofad674. eCollection 2024 Feb.

Authors

Yanhan Shen^{1

2}, McKaylee M Robertson^{1

2}, Sarah G Kulkarni¹, Laura Puzniak³, Joann M Zamparo³, Kristen E Allen³, Thomas M Porter³, Saba A Qasmieh^{1

2}, Christian Grov^{1

4}, Avantika Srivastava^{1

2}, Rebecca Zimba^{1

2}, John M McLaughlin³, Denis Nash^{1

2}

Affiliations

¹ Institute for Implementation Science in Population Health (ISPH), City University of New York (CUNY), New York, New York, USA.
² Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, New York, USA.
³ Pfizer, Inc., Collegeville, Pennsylvania, USA.
⁴ Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, New York, USA.

Abstract

Background: We described the oral nirmatrelvir/ritonavir (NMV/r) and molnupiravir (MOV) uptake among a subgroup of highly vaccinated adults in a US national prospective cohort who were infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between 12/2021 and 10/2022.

Methods: We estimate antiviral uptake within 5 days of SARS-CoV-2 infection, as well as age- and gender-adjusted antiviral uptake prevalence ratios by antiviral eligibility (based on age and comorbidities), sociodemographic characteristics, and clinical characteristics including vaccination status and history of long coronavirus disease 2019 (COVID).

Results: NMV/r uptake was 13.6% (95% CI, 11.9%-15.2%) among 1594 participants, and MOV uptake was 1.4% (95% CI, 0.8%-2.1%) among 1398 participants. NMV/r uptake increased over time (1.9%; 95% CI, 1.0%-2.9%; between 12/2021 and 3/2022; 16.5%; 95% CI, 13.0%-20.0%; between 4/2022 and 7/2022; and 25.3%; 95% CI, 21.6%-29.0%; between 8/2022 and 10/2022). Participants age ≥65 and those who had comorbidities for severe COVID-19 had higher NMV/r uptake. There was lower NMV/r uptake among non-Hispanic Black participants (7.2%; 95% CI, 2.4%-12.0%; relative to other racial/ethnic groups) and among individuals in the lowest income groups (10.6%; 95% CI, 7.3%-13.8%; relative to higher income groups). Among a subset of 278 participants with SARS-CoV-2 infection after 12/2021 who also had a history of prior SARS-CoV-2 infection, those with (vs without) a history of long COVID reported greater NMV/r uptake (22.0% vs 7.9%; P = .001). Among those prescribed NMV/r (n = 216), 137 (63%; 95% CI, 57%-70%) reported that NMV/r was helpful for reducing COVID-19 symptoms.

Conclusions: Despite proven effectiveness against severe outcomes, COVID-19 antiviral uptake remains low among those with SARS-CoV-2 infection in the United States. Further outreach to providers and patients to improve awareness of COVID-19 oral antivirals and indications is needed.

Keywords: CHASING COVID Cohort study; SARS-CoV-2; awareness of antivirals; molnupiravir (MOV); nirmatrelvir-ritonavir (NMV/r).

Abstract

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