Trial Finds No Clinical Benefit for Paxlovid in Vaccinated Patients

TRIAL FINDS NO CLINICAL BENEFIT FOR PAXLOVID IN VACCINATED PATIENTS

PANORAMIC trial reports no reduction in hospitalization or death in a highly vaccinated population

Straight Healthcare
April 2026

The EPIC-HR trial, published in 2022, found that Paxlovid reduced COVID-19-related hospitalizations in unvaccinated individuals. The effects of Paxlovid in a highly vaccinated population have not been studied extensively.

To address this knowledge gap, researchers conducted the PANORAMIC trial, an open-label clinical trial in the United Kingdom that enrolled 3516 higher-risk community-dwelling adults (age ≥ 50 years, OR age ≥ 18 years with coexisting conditions) with COVID-19 (98.6% vaccinated) and symptom onset within 5 days. Patients were randomized to usual care + nirmatrelvir 300 mg plus ritonavir 100 mg (Paxlovid) twice daily for 5 days or usual care alone. At the end of the trial, the primary endpoint, hospitalization or death from any cause within 28 days, occurred in 14/1698 (0.8%) of the Paxlovid group and 11/1673 (0.7%) of the usual-care group (adjusted odds ratio [aOR] 1.18; 95% Bayesian credible interval, 0.55 to 2.62). A secondary outcome—early sustained recovery—favored Paxlovid (33.0% vs. 22.1%; aOR, 1.74; 95% Bayesian credible interval, 1.48 to 2.04). However, the study was open-label, so this endpoint is susceptible to bias. Furthermore, the previous double-blinded EPIC-SR study did not find that Paxlovid reduced symptom duration in standard-risk outpatients.

The PANORAMIC trial does not support the routine use of Paxlovid in vaccinated individuals. Results from a similar, smaller trial, CanTreatCOVID (N=716), were reported simultaneously and also found no benefit with Paxlovid (hospitalization or death: 0.6% with nirmatrelvir–ritonavir vs 1.2% with usual care; OR 0.48, 95% BCI 0.08 to 2.23). The authors of the studies did not provide specific data on comorbidities. However, the population likely reflects that of a typical general practice (average age 55 years, coexisting conditions - 66%). Whether Paxlovid provides a benefit in vaccinated, very high-risk individuals (e.g., morbid obesity, immunocompromised, advanced age) is unknown.