Effect of Paxlovid Treatment during Acute COVID-19 on Long COVID Onset: An EHR-Based Target Trial Emulation from the N3C and RECOVER Consortia

Alexander Preiss, Abhishek Bhatia, Leyna V. Aragon, John M. Baratta, Monika Baskaran, Frank Blancero, M. Daniel Brannock, Robert F. Chew, Ivan Diaz, Megan Fitzgerald, Elizabeth P. Kelly, Andrea Zhou, Thomas W. Carton, Fei Wang, Rainu Kaushal, Christopher G. Chute, Melissa Haendel, Richard Moffitt, Emily Pfaff, N3C Consortium, the RECOVER Cohort

Abstract

Preventing and treating post-acute sequelae of COVID-19 infection (PASC), commonly known as Long COVID, has become a public health priority. This study tests whether Paxlovid treatment in the acute phase of COVID-19 could help prevent the onset of PASC. We used electronic health records from the National Clinical Cohort Collaborative (N3C) to define a cohort of 445,738 patients who had COVID-19 since April 1, 2022, and were eligible for Paxlovid treatment. We used the target trial emulation framework to estimate the effect of Paxlovid treatment on PASC incidence. Compared to the control group, Paxlovid treatment did not have a significant effect on overall PASC incidence. It had a small protective effect against cognitive and fatigue symptoms.