The Briefing provides an at-a-glance view of some important developments in the information universe surrounding COVID-19. The views presented here are solely those of ECRI Horizon Scanning and have not been vetted by other stakeholders.

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Bivalent boosters are beginning to show evidence for their anticipated efficacy against Omicron COVID-19 variants. In early November, Pfizer and BioNTech announced clinical data supporting an improved immune response against Omicron BA.4/BA.5 relative to the original vaccine formulation. A recent preprint of laboratory assessments showed the bivalent vaccine’s potential against BA2.75.5 and BQ1.1, as well.

Vaccination might reduce the risk of post-COVID conditions (PCC, also known as long COVID). Surveyed patients across all 50 states and the District of Columbia were less likely to report PCC symptoms if infected after completing the full original vaccination series. Nonetheless, 15 percent of those surveyed had enduring PCC symptoms at least 2 months after their SARS-CoV-2 infections.

This and other estimates of PCC prevalence (see below) demonstrate the size of the need for care. The Department of Veterans Affairs (VA) aimed to see what that care looks like in its health system. The health records of 200 randomly selected veterans revealed that the diagnosis and management of their PCC is characterized by clinical uncertainty and care fragmentation.

Both studies demonstrate the limitations of qualitative research, but also highlight the need for new treatments and innovative ways to test them (see Topics to Watch).

Adaptive Platform Trials to Accelerate the Development of Effective Treatments for COVID-19 and Post-COVID Conditions

At a Glance

  • Adaptive platform trials (APTs) simultaneously investigate multiple interventions under a shared study protocol and are designed to quickly adapt as new evidence becomes available.
  • APT methodology could help identify effective treatments faster and with fewer resources than traditional randomized controlled trials (RCTs).
  • The urgent need for rapid evidence generation and dissemination of effective treatments during the COVID-19 pandemic markedly increased the use of APT methodology compared with historical levels. Even before the COVID-19 pandemic, APTs were gaining traction to evaluate emerging population health and health system needs.
  • Multiple APTs are ongoing, both nationally and internationally, to investigate treatments for acute COVID-19 and post-COVID conditions (PCC). This methodology may help effective treatments reach patients sooner than via traditional RCTs.

Nirmatrelvir Plus Ritonavir (Paxlovid) to Treat Post-COVID Conditions

At a Glance

  • No medications are currently authorized or approved to treat millions of adults in the United States living with post-COVID conditions (PCC), which can encompass a broad range of potentially debilitating symptoms that persist after acute SARS-CoV-2 infection.
  • Paxlovid is an oral combination of the antiviral drugs nirmatrelvir and ritonavir. It was previously authorized by the FDA to treat acute COVID-19 in high-risk patients, after a clinical trial demonstrated it reduced the risk of hospitalization and death by 89%.
  • Paxlovid is now being investigated to treat adults with PCC. Research suggests that it might improve PCC symptoms by clearing persistent viral infection and reducing inflammation associated with chronic immune activation.
  • The National Institutes of Health is investigating the use of Paxlovid to improve PCC symptoms in a phase 3 clinical trial expected to be completed in January 2024.
  • A 15-day course of Paxlovid for treating PCC is expected to cost about $1590.

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Commentary in this COVID-19 Scan reflects preliminary views of ECRI Horizon Scanning and internal ECRI stakeholders.
The information contained in this document has not been vetted by other stakeholders.

We welcome your comments on this Scan. Send them by email to [email protected].

Posted: November 17, 2022

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