News Roundup: Paxlovid for Omicron, USPSTF Recommendations

Volume 18, Issue 4

Every so often, enough exciting news emerges over the course of one week to necessitate covering more than one topic in this column. This past week just so happens to be one of those weeks.

Without further ado, let’s dive into the most exciting news stories from this past week.

Point 1: Paxlovid Effective Against Omicron for Select Patients

Nirmatrelvir/ritonavir (NR), which is branded as Paxlovid, emerged as a game changer for managing COVID-19 infections early in the Omicron wave. As I documented in a prior installment of Talking Therapeutics, my personal experience with Paxlovid during my BA.2 infection was very good. Despite many positive anecdotes and empirical evidence from use in clinical practice, the data supporting the use of NR was derived during the Delta era. Compared to the Omicron variant, the Delta strain of COVID-19 is more virulent and more capable of causing severe disease.

This week, a new study in The New England Journal of Medicine evaluates the clinical impact of NR use in patients infected with the Omicron variant. This study included 109,254 patients, of which 3902 (4%) received NR during the study period.

Patients who were 65 years of age or older experienced a lower rate of hospitalization due to COVID-19 when treated with NR (14.7 cases per 100,000 person-days) compared to those who did not receive NR (58.9 cases per 100,000 person-days) (adjusted hazard ratio, 0.27; 95% CI, 0.15 to 0.49).

“The adjusted hazard ratio for death due to COVID-19 was 0.21 (95% CI, 0.05 to 0.82),” researchers said.

The story was not the same for patients aged 40 to 64 years, who did not derive a benefit from NR. This was true even for younger patients with prior immunity due to vaccination or recovered infection, although the number of patients included in this group was probably too small to detect a difference.

Point 2: Differences in Statin Recommendations for Primary Prevention

The US Preventive Services Task Force (USPSTF) just released their updated recommendations for statin use for the primary prevention of cardiovascular disease (CVD). The chief recommendations are as follows:

• “The USPSTF recommends that clinicians prescribe a statin for the primary prevention of CVD for adults aged 40 to 75 years who have 1 or more CVD risk factors (ie, dyslipidemia, diabetes, hypertension, or smoking) and an estimated 10-year CVD risk of 10% or greater. (B recommendation)
• The USPSTF recommends that clinicians selectively offer a statin for the primary prevention of CVD for adults aged 40 to 75 years who have 1 or more of these CVD risk factors and an estimated 10-year CVD risk of 7.5% to less than 10%. The likelihood of benefit is smaller in this group than in persons with a 10-year risk of 10% or greater. (C recommendation)”

These recommendations largely reflect the other authoritative document on this topic, the 2018 American Heart Association/American College of Cardiology/multisociety (AHA/ACC/MS) clinical practice guideline. Some key distinctions revolve around patients with more nuanced risk factors.

For instance, the AHA/ACC/MS document provides specific recommendations for patients with familial hypercholesterolemia, as well as for using sophisticated tests like the coronary artery calcium score to further risk stratify patients with moderate risk features.