Beyond oxygen requirement: rethinking patient selection for oral antiviral therapy to inform trial design in the omicron era
- 1Maladies infectieuses, AP-HP Hôpital Raymond Poincaré, Université Paris-Saclay, Garches, France; UMR1173, Université Versailles Saint-Quentin, Montigny-Le-Bretonneux, France; Corresponding author: B. Davido, MD, PhD, Infectious Diseases Department, Raymond-Poincaré Teaching Hospital, 104 boulevard Raymond Poincaré, Garches 92380, France.
- 2Virulence Bactérienne et Infections Chroniques, INSERM U1047, Univ Montpellier, Service des Maladies Infectieuses et Tropicales, CHU Nîmes, Nîmes, France
Abstract
Current COVID-19 therapeutic recommendations for oral antiviral therapy rely on a stage-based framework established during the first pandemic waves, restricting treatment to patients presenting within five days of symptom onset who do not require supplemental oxygen, whereas corticosteroids are recommended for hospitalized patients requiring supplemental oxygen. Although this strategy remains supported by randomized evidence, the biological and clinical landscape of COVID-19 has profoundly evolved with widespread hybrid immunity, Omicron sublineages, and an older and immunocompromised hospitalized population. We propose that oral antiviral eligibility, primarily in the context of nirmatrelvir/ritonavir, should progressively move beyond an oxygen-centered eligibility algorithm toward an integrated clinical assessment including symptom duration, host characteristics, pulmonary involvement on chest CT, virological burden (when available), and oxygen requirement. Importantly, this perspective does not challenge early antiviral initiation within the approved therapeutic window. Rather, it argues that future studies should determine whether a more integrated patient selection strategy can optimize the use of oral antiviral therapy in contemporary COVID-19 caused by Omicron sublineages.
Related
- Adjuvant Therapy in Resected Adrenocortical Carcinoma: Current Evidence and Patient Selection
- A requirement-driven framework for cloud service provider selection using AHP, QFD, and TOPSIS
- Age is the wrong axis: rethinking surgical selection for octogenarians with early-stage non-small cell lung cancer
- Rethinking gadolinium hypersensitivity management: from corticosteroid premedication to evidence-informed alternative GBCA selection
- Response to antiviral therapy in haematopoietic stem cell transplant recipients with cytomegalovirus (CMV) reactivation according to the donor CMV serological status
BibTeX
@article{davido2026beyond,
title = {{Beyond oxygen requirement: rethinking patient selection for oral antiviral therapy to inform trial design in the omicron era}},
author = {Benjamin Davido and Paul Loubet},
journal = {International Journal of Infectious Diseases},
year = {2026},
month = oct,
doi = {10.1016/j.ijid.2026.109171},
url = {https://doi.org/10.1016/j.ijid.2026.109171},
note = {CC BY},
}
RIS
TY - JOUR
TI - Beyond oxygen requirement: rethinking patient selection for oral antiviral therapy to inform trial design in the omicron era
AU - Benjamin Davido
AU - Paul Loubet
PY - 2026
DA - 2026/10/30
JO - International Journal of Infectious Diseases
DO - 10.1016/j.ijid.2026.109171
UR - https://doi.org/10.1016/j.ijid.2026.109171
AB - Current COVID-19 therapeutic recommendations for oral antiviral therapy rely on a stage-based framework established during the first pandemic waves, restricting treatment to patients presenting within five days of symptom onset who do not require supplemental oxygen, whereas corticosteroids are recommended for hospitalized patients requiring supplemental oxygen. Although this strategy remains supported by randomized evidence, the biological and clinical landscape of COVID-19 has profoundly evolved with widespread hybrid immunity, Omicron sublineages, and an older and immunocompromised hospitalized population. We propose that oral antiviral eligibility, primarily in the context of nirmatrelvir/ritonavir, should progressively move beyond an oxygen-centered eligibility algorithm toward an integrated clinical assessment including symptom duration, host characteristics, pulmonary involvement on chest CT, virological burden (when available), and oxygen requirement. Importantly, this perspective does not challenge early antiviral initiation within the approved therapeutic window. Rather, it argues that future studies should determine whether a more integrated patient selection strategy can optimize the use of oral antiviral therapy in contemporary COVID-19 caused by Omicron sublineages.
SN - 1201-9712
SN - 1878-3511
ER -