Is Paxlovid Less Effective for Adults Under 65?

paxlovid photo composite

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Key Takeaways

  • A study in Israel found that Paxlovid may not reduce the risks of hospitalization and death in people younger than 65.
  • The study evaluated very few participants who are at high risk, and younger adults are on average less likely to be severely ill from COVID-19.
  • The antiviral treatment can still help shorten the duration of the illness and alleviate symptoms.

While Paxlovid can reduce the risks of hospitalization and death for adults who are 65 and older, the antiviral treatment made little to no difference for those aged 40 to 65, according to a recent study published in the New England Journal of Medicine.

Researchers in Israel evaluated over 100,000 patients, 3,902 of whom received Paxlovid during the study period. However, only a minority of participants who were determined to be at high risk received the treatment, which may have affected the results. 

The results may appear alarming, but they make sense, according to Jeffrey Klausner, MD, MPH, an infectious disease specialist at the University of Southern California, who was not affiliated with the study.

People under 65 generally have a lower risk of being severely ill from COVID-19, Klausner explained, especially if they have no underlying conditions. With that in mind, the younger participants were expected to fare similarly with or without Paxlovid, he said.

Providers shouldn’t ration their Paxlovid supplies exclusively for older adults based on these findings alone, Klausner added, because the drug can reduce the duration of illness in people of all ages. Furthermore, Paxlovid may have other important benefits, such as reducing the risk of developing long COVID, but that’s still being studied.

Klausner said he would still recommend Paxlovid for patients who are under 65 to reduce symptoms and speed up recovery.

Paxlovid Supply

Paxlovid remains in steady supply in the U.S., so there isn’t a pressing public health reason to reserve it for certain age groups, Klausner said.

Currently, the drug is authorized for people 12 and older, but changes may occur if federal funding for the antiviral treatment runs out, he added.

While the Biden administration purchased 10 million courses of Paxlovid in June, the COVID-19 funding might run dry by this fall and the cost burden would fall on insurance companies. The free COVID-19 test initiative is set to be halted this week.

“Some private insurers may not be willing to pay for younger patients who have a very low risk for severe outcomes,” Klausner said. “This ‘cost effectiveness’ question may become more important.”

What This Means For You

Paxlovid can significantly reduce the risk of hospitalizations and death from COVID-19 in people older than 65. The drug may be less effective in younger adults who have a smaller baseline risk to start out with.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

1 Source
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Arbel R, Wolff Sagy Y, Hoshen M, et al. Nirmatrelvir use and severe Covid-19 outcomes during the Omicron surge. N Engl J Med. Published online August 24, 2022. doi:10.1056/NEJMoa2204919

By Claire Wolters
Claire Wolters is a staff reporter covering health news for Verywell. She is most passionate about stories that cover real issues and spark change.