Antivirals are underutilized for COVID-19 in older adults and those with comorbidities despite their increased risk for hospitalization, according to a report1 from the Centers for Disease Control and Prevention (CDC).
"Despite the proven benefit of COVID-19 antivirals (eg, nirmatrelvir/ritonavir, remdesivir, or molnupiravir) in preventing severe outcomes, data suggest that their use is low among older adults," observe lead author Julia Raykin, PhD, Office of Public Health Data, Surveillance, and Technology, CDC, Atlanta, GA, and colleagues.
The investigators sought to determine patterns and factors associated with COVID-19 antiviral prescribing during the period between June 2023 to September 2025.They accessed anonymized electronic health records from Truveta, which curates data from health care organizations nationwide.Their analysis broke down the period by seasons, and accounted for surges in SARS-CoV-2 circulation.
A total of 482,467 outpatients aged ≥65 years with laboratory confirmed and/or ICD-10-CM coded diagnosis of COVID-19 in primary care settings were included in the study.The cohort was differentiated by age, sex, ethnicity, COVID-19 vaccination status, comorbidities, and use of immunosuppressive medication.
Raykin and colleagues found that an antiviral had been prescribed within 7 days of the outpatient visit to 147,715 (31%), while 334,741 (69%) did not receive the prescription. The percentages varied with the season, with a greater percentage (23.4%) receiving it during fall-winter 2024-25 than during spring 2024 (21.5%), spring 2025 (16.5%), and summer 2025 (19.4%); but that was less than in summer 2023 (36.7%), fall-winter 2023-24 (37.6%) and summer 2024 (37.6%).
"The receipt of an antiviral prescription varied across periods and seemed to correspond with intensity of SARS-CoV-2 circulation, suggesting that perception of risk related to SARS-CoV-2 activity rather than individual risk might be a factor in clinical decision-making about treatment," the investigators indicated.
In a divergence from the analysis conducted in 2023, this study found that the percentage who received an antiviral increased with increasing age.Raykin and colleagues welcomed this finding, which suggested to them that there has been increasing recognition that risk for severe disease increases with age.
Their analysis also found, however, that persons with comorbidities were less likely to receive an antiviral prescription than were those without comorbidities; despite being at greater risk for severe outcomes from COVID-19.
What You Need to Know
Among more than 482,000 outpatients aged ≥65 years with COVID-19, only 31% received an antiviral prescription within 7 days of diagnosis, despite clear evidence that treatments such as nirmatrelvir/ritonavir, remdesivir, and molnupiravir reduce the risk of severe outcomes.
Antiviral use fluctuated by season and tended to increase during periods of higher SARS-CoV-2 circulation, suggesting clinicians may be influenced more by current outbreak intensity than by a patient’s personal risk factors.
Despite their elevated risk for severe disease, patients with comorbid conditions were less likely to receive antivirals, possibly due to concerns about drug interactions—although evidence suggests these interactions can often be safely managed, according to the Centers for Disease Control and Prevention investigators.
"This might reflect complicated medication profiles of older adults as well as health care provider concerns about the potential drug interactions," the investigators suggest.They note, however, "studies suggest these interactions can be safely managed."
The analysis also revealed a higher percentage of antiviral prescriptions among persons who had received the COVID-19 vaccine.This might reflect, the investigators posit, that persons who engage in preventive care are more likely to seek treatment when they are ill.Since COVID-19 vaccination rates have declined, however, the investigators emphasize the importance of recommending primary prevention strategies to protect against severe COVID-19 in older adults.
"Health care providers and patients should be educated about the benefits and risks of COVID-19 antiviral treatment," Raykin and colleagues conclude. "Accurate assessment of risk for severe disease and options for treatment are important for early initiation to prevent severe outcomes."
Reference
1. Raykin J, Rochlin I, Wiegand R, et al. COVID-19 Antiviral prescription receipt among outpatients aged ≥65 years—United States, June 1, 2023-Septermber 30, 2025. MMWR 2026, February 19; 75(6):69-76.
