Risk Factors for Seeking Medical Care Following Nirmatrelvir-Ritonavir (Paxlovid) Treatment for COVID-19: "Symptom Rebound"

Nirmatrelvir plus ritonavir (NPR) has been approved for treating mild to moderate COVID-19 in high-risk adults but concerns about rebound effects have limited its use. This study aimed to identify individuals at risk of seeking medical care among high-risk non-hospitalized patients treated with NPR from 1 January 2022 to 31 December 2022, at our institution. Our outcome variable was the composite of subsequent evaluation in the Emergency Department or inpatient admission within four weeks of their NPR treatment. Of 369 patients who received NPR treatment, the mean (SD) age was 59.3 (+/- 13.8) years; 64% (236) were female, and 77.7% (281) were white. The incidence of the composite event was 6.8% (25/369). In multivariable logistic regression, factors for seeking medical care following NPR treatment were female sex (OR 4.6; 95% CI 1.4-15.3; p = 0.013), myocardial infarction (OR 4.1; 95% CI 1.4-11.8; p = 0.011), chronic lung disease (CLD) except asthma and chronic obstructive pulmonary disease (COPD) (OR = 3.9, 95% CI 1.1-13.5; p = 0.03), and diabetes mellitus with complications (OR 6.9; 95% CI 2.0-23.3; p = 0.002) while alcohol users (OR 0.39; 95% CI 0.2-0.9; p = 0.038) were less likely to seek medical care. Larger cohorts are necessary to further assess and confirm these risk factors.