While outpatient antiviral treatment is effective at reducing those risks, fewer than one-half of adults aged 65 years and older with an outpatient COVID-19 diagnosis received a recommended COVID-19 antiviral medication, according to a new study led by researchers from the CDC. Additionally, those who probably need it the most are the least likely to receive it, the authors reported.
The article in the CDC’s Morbidity & Mortality Weekly Report (MMWR) noted that 48% of adults aged 65 to 74 years, 44% among those aged 75 to 89 years, and 35% among those aged ≥90 years with an outpatient COVID-19 diagnosis received them.
“Among patients with severe outcomes, 21% had received an outpatient COVID-19 antiviral, compared with 47% of patients without severe outcomes,” the researchers pointed out, adding, “Lower prevalence of outpatient antiviral treatment in the oldest age groups highlights the continued need to improve COVID-19 antiviral use by increasing awareness and testing, and facilitating early treatment in these groups.”
Their study found that prevalence of receipt of antivirals decreased progressively and substantially with increasing age in persons aged 65 to 90 years or older, after controlling for the number of underlying medical conditions and other demographic factors.
The MMWR article advised that several real-world studies, including those conducted since the emergence of SARS-CoV-2 Omicron variant in January 2022, have shown that COVID-19 antivirals effectively prevent hospitalization and death. “Because older age is a strong risk factor for severe COVID-19–associated outcomes, and COVID-19 hospitalizations continue to disproportionately affect older patients, treatment of COVID-19, including cases in older adults, is critical to the prevention of severe outcomes,” the authors emphasized.
Among older patients, the authors write that frequent self-reported reasons for nonuse of antivirals include:
• The presence of mild signs and symptoms
• Lack of awareness of eligibility
• Absence of a provider recommendation.
The authors noted that other potential barriers to treatment among older patients include delays in seeking treatment after symptom onset and missing the treatment window (5-7 days after symptom onset).
Additional challenges to COVID-19 antiviral use include obtaining testing, acquiring an antiviral prescription after receiving a positive SARS-CoV-2 test result and accessing treatment, with each step potentially requiring a separate visit to a healthcare facility.
“Older age is associated with increasing numbers of comorbidities and potentially related medications, which might lead to patient and provider hesitation to commence treatment, based on concerns about drug interactions with nirmatrelvir-ritonavir or contraindications among patients with severe hepatic and renal disease,” the researchers explained. “Lower antiviral use prevalence among persons who have more underlying medical conditions might be consistent with concern about drug interactions or difficulty in temporarily discontinuing or adjusting other concomitantly prescribed medications in older persons.”
The authors added that absolute contraindications are unlikely to be the only reason for this finding because the decrease in antiviral use prevalence by age persisted even after controlling for CCI score (a validated numerical value for the Medicare population used to predict 1-year mortality). “In addition, the use of the well-tolerated oral molnupiravir and intravenous remdesivir, which have few medication contraindications, increased only slightly with increasing age, and this analysis suggests that these medications have not closed the age-related treatment gap,” the authors point out. “Older adults and their providers might also have concerns about possible rebound after treatment, including the need to isolate should symptoms recur, although a review found similar frequencies of viral rebound among persons who received or did not receive treatment for COVID-19.”
The researchers urged pharmacists and other healthcare professionals to not only discuss COVID-19 vaccination and access to early sensitive diagnostics such as polymerase chain reaction testing with older adults, but to also educate them about COVID-19 treatment for mild-or-moderate infection.
“Public health efforts to address provider hesitancy and patient knowledge of COVID-19 antivirals and to eliminate barriers to COVID-19 diagnostics and treatment are needed, especially among older adults,” according to the article.
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