Pediatric nirmatrelvir/ritonavir prescribing patterns during the COVID-19 pandemic

Bose-Brill, S; Hirabayashi, K; Schwimmer, E; et al., Hospital Pediatrics, August 2024

View Publication on PubMed

August 2024
Hospital Pediatrics

Short Summary

This RECOVER study looks at a medicine called nirmatrelvir/ritonavir, which is used to treat COVID-19 in teens and adults who are more likely to be hospitalized from COVID-19. Researchers wanted to understand why doctors might give this medicine to teens ages 12 to 17. They reviewed electronic health records (EHRs) from January 2022 to August 2023 to find which teens got this medicine after testing positive for COVID-19. Out of almost 21,000 teens with COVID-19, only 408 got the medicine within 5 days of diagnosis. The study found that teens with long-term health problems were 2.5 times more likely to get the medicine. Those with comorbidities (more than 1 ongoing health problem) were more likely to receive it. But most teens with 1 or more health problems did not receive this medication. This could be a reason why many teens with COVID-19 need to be hospitalized. The study also found that Hispanic or Latino kids were less likely to get the medicine compared to non-Hispanic, white kids. This study shows that kids with chronic health issues are more likely to get nirmatrelvir/ritonavir, but not many kids are getting this medicine overall.

This summary was prepared by the RECOVER Initiative.

Publication Details

DOI: 10.1542/hpeds.2023-007132

Abstract

Objectives: This study seeks to identify demographic and clinical factors prompting clinician prescribing of nirmatrelvir/ritonavir to pediatric patients for management of coronavirus disease 2019 (COVID-19) infection.

Methods: Patients aged 12 to 17 years with a COVID-19 infection and nirmatrelvir/ritonavir prescription during an outpatient clinical encounter within a PEDSnet-affiliated institution between January 2022 and August 2023 were identified using electronic health record data. A multivariate logistic regression analysis was used to estimate odds of nirmatrelvir/ritonavir prescription after adjusting for various factors.

Results: A total of 20 959 patients aged 12 to 17 years were diagnosed with a COVID-19 infection on the basis of an electronic health record-documented positive polymerase chain reaction or antigen test or diagnosis during an outpatient clinical visit. Of these patients, 408 received a nirmatrelvir/ritonavir prescription within 5 days of diagnosis. Higher odds of nirmatrelvir/ritonavir treatment were associated with having chronic or complex chronic disease (chronic: odds ratio [OR] 2.50 [95% confidence interval (CI) 1.83-3.38]; complex chronic: OR 2.21 [95% CI 1.58-3.08]). Among patients with chronic disease, each additional body system conferred 1.18 times higher odds of treatment (95% CI 1.10-1.26). Compared with non-Hispanic white patients, Hispanic patients (OR 0.61 [95% CI 0.44-0.83]) had lower odds of treatment.

Conclusions: Children with chronic conditions are more likely than those without to receive nirmatrelvir/ritonavir prescriptions. However, nirmatrelvir/ritonavir prescribing to children with chronic conditions remains infrequent. Pediatric data concerning nirmatrelvir/ritonavir safety and effectiveness in preventing severe disease and hospitalization are critical optimizing clinical decision-making and use among children.

Authors

Seuli Bose-Brill, Kathryn Hirabayashi, Emmanuel Schwimmer, Nathan M Pajor, Suchitra Rao, Asuncion Mejias, Ravi Jhaveri, Christopher B Forrest, L Charles Bailey, Dimitri A Christakis, Deepika Thacker, Patrick C Hanley, Payal B Patel, Jonathan D Cogen, Jason P Block, Priya Prahalad, Vitaly Lorman, Grace M Lee, Researching COVID to Enhance Recovery consortium

Keywords

Humans; Ritonavir/therapeutic use; Child; Female; Male; Adolescent; COVID-19 Drug Treatment; Practice Patterns, Physicians'/statistics & numerical data; Drug Combinations; COVID-19/epidemiology; SARS-CoV-2; Antiviral Agents/therapeutic use; Lopinavir/therapeutic use; Retrospective Studies