Introduction and Objective: SARS-CoV-2 infection is associated with increased risk of diabetes mellitus (DM). Paxlovid (nirmatrelvir/ritonavir) is an antiviral approved for individuals at high risk for severe SARS-CoV-2 infection, but its effect on post-SARS-CoV-2 DM risk is unknown. We examined whether outpatient Paxlovid use was associated with incident DM over 2 years in adults aged 50-80 with positive SARS-CoV-2 test.Methods: We conducted a retrospective cohort study using electronic health records from 31 PCORnet health systems in NIH RECOVER program. We included adults aged 50-80 with a positive SARS-CoV-2 test after December 2021 and no prior DM, Paxlovid contraindications, or other SARS-CoV-2 treatments. Paxlovid users (treated 1 day priorto 5 days after a positive test; n=20,949) were compared with nonusers (n=110,666). The outcome was monthly DM incidence over 2 years from positive test date. Cause-specific cumulative DM incidence was estimated using inverse probability weighting, adjusting for baseline demographics, comorbidities, and other medications.Results: Among 131,615 eligible adults, 16% received Paxlovid. Overall mean age was 62 years (SD=8) and 62% were female. Two years post infection, cumulative DM incidence was 2.1% with Paxlovid vs 3.1% without, an absolute difference of -1.0% (95% CI, -1.25 to -0.73).Conclusion: Paxlovid use (versus none) during acute SARS-CoV-2 infection was associated with lower two-year diabetes incidence.
B. Rasouli: None. S. Rifas-Shiman: None. J.G. Young: None. T. Eggerman: None. B. French: None. M. Hivert: None. S. McGrath: None. A.C. Powers: None. J. Lyons: None. R.L. Rothman: Research Support; Current; Dexcom, Inc. J.S. Schildcrout: None. J.P. Block: None.
U01DK137533
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