Pediatric Nirmatrelvir/Ritonavir Prescribing Patterns During the COVID-19 Pandemic
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Study to identify demographic and clinical factors prompting clinician prescribing of nirmatrelvir/ritonavir to pediatric patients for management of coronavirus disease 2019 (COVID-19) infection.
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This study investigates factors influencing the prescription of nirmatrelvir/ritonavir (Paxlovid) to pediatric patients aged 12–17 years for the treatment of COVID-19, leveraging data from the PEDSnet network. This national cohort study included electronic health records from outpatient visits between January 2022 and August 2023, identifying a group of 20,959 patients diagnosed with COVID-19 and assessing the factors influencing the prescription of nirmatrelvir/ritonavir within five days of diagnosis. The study used multivariate logistic regression to determine the odds of receiving this treatment based on demographics and clinical characteristics.
The analysis found that only 408 of the 20,959 pediatric patients (1.9%) received a prescription for nirmatrelvir/ritonavir within the critical 5-day window after COVID-19 diagnosis. Key factors associated with higher odds of receiving the medication included having chronic or complex chronic conditions, obesity, and prior COVID-19 vaccination. Hispanic patients were less likely to receive the treatment compared to non-Hispanic white patients. Additionally, the study observed that patients with chronic diseases, particularly those affecting multiple body systems, were more likely to be prescribed nirmatrelvir/ritonavir, though overall prescribing rates remained low. This highlights a gap in treatment utilization, especially for children at high risk for severe COVID-19.
The study suggests that although pediatric use of nirmatrelvir/ritonavir is authorized under emergency use authorization, it remains infrequent, especially for children with chronic conditions, despite their higher risk for severe disease. These findings emphasize the need for further research into the safety and effectiveness of the treatment in pediatric populations and the need for more equitable prescribing practices across racial and ethnic groups.
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Bose-Brill S, Hirabayashi K, Schwimmer E, Pajor N, Rao S, Mejias A, Jhaveri R, et al. August 2024. “Researching COVID to Enhance Recovery consortium; Pediatric Nirmatrelvir/Ritonavir Prescribing Patterns During the COVID-19 Pandemic.” Hosp Pediatrics. 14(8): e341–e348.
DOI: 10.1542/hpeds.2023-007132
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