COVID-19 Oral Antivirals: Low Uptake Linked to Misperceived Risk Status

The uptake of oral antivirals for COVID-19 infection is low among eligible adults in the United States, potentially due to differences between perceived vs actual risk for severe outcomes. These study findings were published in Infectious Diseases and Therapy.

Researchers conducted an online cross-sectional survey in April 2023 to examine the connection between perceived risk for severe COVID-19 outcomes and the use of oral antivirals in high-risk patients. The study included adult patients with at least 1 confirmed prior infection who reported no long COVID symptoms at enrollment. The primary outcome was the use of COVID-19 oral antivirals within 5 days of suspected infection. Eligibility for oral antiviral treatment was determined via Centers for Disease Control and Prevention (CDC) guidelines, and estimated prevalence of oral antiviral use was determined via robust Poisson models.

A total of 4034 adults (median age, 53.9 years; women, 61.1%) completed the survey, of whom 78.9% had at least 1 underlying condition and 63.4% reported receipt of at least 3 COVID-19 vaccine doses. The majority of patients (66.8%) were eligible for oral antiviral treatment based on CDC criteria.

Among the population of antiviral-eligible adults, 18.5% (95% CI, 15.9-21.2) considered themselves to be at high risk for severe COVID-19 infection. A high perceived risk for severe outcomes was most commonly observed in patients who reported a household income below $100,000; lack of full-time employment; at least 1 underlying condition; and receipt of at least 3 COVID-19 vaccine doses (all P <.05). Other factors significantly associated with high self-perceived risk included immunocompromised status and history of asthma, chronic obstructive pulmonary disease, diabetes, heart disease, hypertension, liver disease, major depressive disorder, and overweight or obesity (all P <.05).

In multivariable analyses, patients with vs without high self-perceived risk for severe COVID-19 outcomes more commonly reported use of oral antivirals within 5 days of suspected infection (adjusted prevalence ratio [aPR], 1.72; 95% CI, 1.23-2.40), awareness of oral antiviral treatment (aPR, 1.11; 95% CI, 1.03-1.20), receipt of a prescription (aPR, 1.47; 95% CI, 1.08-2.01), and use of any oral antiviral treatment (aPR, 1.61; 95% CI, 1.16-2.24).

Study limitations include the cross-sectional design, potential misclassification bias due to the use of self-reported data, and potential underestimation in regard to the prevalence of health conditions, oral antiviral use, and prior COVID-19 infection.

“This misperception of risk status, and thus antiviral eligibility, may be a contributor to suboptimal COVID-19 oral antiviral uptake to date, despite broad awareness of COVID-19 treatment options,” the researchers concluded.

Disclosure: This study was support in part by Pfizer, Inc., and multiple study authors reported affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Infectious Disease Advisor