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. 2024 Aug 1;14(8):e341-e348.
doi: 10.1542/hpeds.2023-007132.

Pediatric Nirmatrelvir/Ritonavir Prescribing Patterns During the COVID-19 Pandemic

Seuli Bose-Brill  1 , Kathryn Hirabayashi  2 , Emmanuel Schwimmer  1 , Nathan M Pajor  3 , Suchitra Rao  4 , Asuncion Mejias  5 , Ravi Jhaveri  6 , Christopher B Forrest  2 , L Charles Bailey  2 , Dimitri A Christakis  7 , Deepika Thacker  8 , Patrick C Hanley  9 , Payal B Patel  7 , Jonathan D Cogen  7 , Jason P Block  10 , Priya Prahalad  11 , Vitaly Lorman  2 , Grace M Lee  12 ; Researching COVID to Enhance Recovery consortium
Affiliations

Pediatric Nirmatrelvir/Ritonavir Prescribing Patterns During the COVID-19 Pandemic

Seuli Bose-Brill et al. Hosp Pediatr. .

Abstract

Objectives: This study seeks to identify demographic and clinical factors prompting clinician prescribing of nirmatrelvir/ritonavir to pediatric patients for management of coronavirus disease 2019 (COVID-19) infection.

Methods: Patients aged 12 to 17 years with a COVID-19 infection and nirmatrelvir/ritonavir prescription during an outpatient clinical encounter within a PEDSnet-affiliated institution between January 2022 and August 2023 were identified using electronic health record data. A multivariate logistic regression analysis was used to estimate odds of nirmatrelvir/ritonavir prescription after adjusting for various factors.

Results: A total of 20 959 patients aged 12 to 17 years were diagnosed with a COVID-19 infection on the basis of an electronic health record-documented positive polymerase chain reaction or antigen test or diagnosis during an outpatient clinical visit. Of these patients, 408 received a nirmatrelvir/ritonavir prescription within 5 days of diagnosis. Higher odds of nirmatrelvir/ritonavir treatment were associated with having chronic or complex chronic disease (chronic: odds ratio [OR] 2.50 [95% confidence interval (CI) 1.83-3.38]; complex chronic: OR 2.21 [95% CI 1.58-3.08]). Among patients with chronic disease, each additional body system conferred 1.18 times higher odds of treatment (95% CI 1.10-1.26). Compared with non-Hispanic white patients, Hispanic patients (OR 0.61 [95% CI 0.44-0.83]) had lower odds of treatment.

Conclusions: Children with chronic conditions are more likely than those without to receive nirmatrelvir/ritonavir prescriptions. However, nirmatrelvir/ritonavir prescribing to children with chronic conditions remains infrequent. Pediatric data concerning nirmatrelvir/ritonavir safety and effectiveness in preventing severe disease and hospitalization are critical optimizing clinical decision-making and use among children.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES: Dr Brill reports previous funding from Novartis and Regeneron Pharmaceuticals for research support. Dr Lee serves on the Platform for Advanced Scientific Computing advisory board for United Health Group. Dr Patel reports funding from the National Institutes of Health. Dr Rao reports previous grant support from GSK and Biofire. Dr Mejias reports funding from Janssen and Merck for research support, Janssen, Merck, and Sanofi-Pasteur for advisory board participation, and Sanofi-Pasteru and AstraZeneca for continuing medical education lectures. Dr Jhaveri is a consultant for AstraZeneca, Seqirus, and Dynavax, and receives an editorial stipend from Elsevier and the Pediatric Infectious Diseases Society, and royalties from Up To Date/Wolters Kluwer. All other authors have indicated they have no conflicts of interest relevant to this article to disclose.

Figures

FIGURE 1
FIGURE 1
Cohort selection flowchart. Figure 1 depicts each step of the cohort selection process, including the numbers of patients excluded based on the eligibility criteria for this analysis. PCR, polymerase chain reaction.
FIGURE 2
FIGURE 2
Forest plot of logistic regression ORs. Figure 2 is a forest plot of ORs (ie, points) and their 95% CIs (ie, lines through each point) generated by multivariate adjusted logistic regression. ORs <1.0 represent lower odds of nirmatrelvir/nitonavir prescription receipt associated with a specific predictor compared with its reference value (see Methods). ORs >1.0 represent higher odds of prescription receipt. NH, non-Hispanic.
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References

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