Pediatric nirmatrelvir/ritonavir prescribing patterns during the COVID-19 pandemic
Bose-Brill, S; Hirabayashi, K; Schwimmer, E; et al., Hospital Pediatrics
Published
August 2024
Journal
Hospital Pediatrics
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