AI Article Synopsis

  • Since the COVID-19 pandemic began in 2020, various treatments have been developed to alleviate symptoms and prevent severe illness.
  • Paxlovid, an antiviral medication, gained emergency authorization in December 2021 for non-hospitalized patients to reduce the risk of severe disease.
  • Recent reports have noted instances of symptom relapse (COVID-19 rebound) in patients after Paxlovid treatment, although these cases typically involve mild symptoms and do not require further antiviral therapy.

Article Abstract

Since the declaration of COVID-19 as a pandemic in 2020, several therapies have been developed to reduce symptoms of COVID-19 infection and prevent progression. Paxlovid is an antiviral that was authorized for emergency use in December 2021 for non-hospitalized symptomatic patients with COVID-19 to prevent progression to severe disease. Relapse of symptoms following a period of improvement after treatment with Paxlovid has been described recently. Data are limited, but the disease course in available case reports is usually mild and requires no additional antiviral treatment. We present the cases of COVID-19 relapse (COVID-19 rebound) in two patients following treatment with Paxlovid.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9308388PMC
http://dx.doi.org/10.7759/cureus.26239DOI Listing

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Introduction: In May 2022, the Centers for Disease Control and Prevention disseminated an alert advising that "a few" persons with Nirmatrelvir/ritonavir (NM/R)-associated rebound of COVID-19 infection had been identified. Three case reports appearing as pre-print postings described the first cases. Analyses in March 2023 by NM/R's manufacturer and the Food and Drug Administration (FDA) reported no association between NM/R and COVID-19 rebound in a large phase 3 randomized clinical trial.

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Paxlovid for the treatment of COVID-19: a systematic review and meta-analysis.

J Infect Dev Ctries

August 2024

Department of Cardiology, Shidong Hospital, Yangpu District, Shidong Hospital affiliated to University of Shanghai for Science and Technology, 999 Shiguang Road, Shanghai 200438, China.

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  • - Paxlovid (nirmatrelvir/ritonavir) is an innovative oral antiviral medication for mild to moderate COVID-19, given over five days; this meta-analysis assessed its effectiveness based on various studies up to March 2023.
  • - The findings showed that Paxlovid significantly reduced risks of hospitalization, all-cause mortality, and ICU admissions, as well as shortened hospital stays and viral clearance time compared to control groups.
  • - Despite these benefits, no significant differences were observed regarding COVID-19 rebound rates between Paxlovid and control groups, highlighting its overall effectiveness as a treatment option for COVID-19 patients.
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Clinical rebound after treatment with nirmatrelvir/ritonavir in COVID-19.

BMC Infect Dis

September 2024

Robert J. Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, 710 N Lake Shore Drive, Chicago, IL, 60611, USA.

Background: Nirmatrelvir/ritonavir (NM/r) is a safe and effective oral antiviral therapeutic used for treatment of mild-to-moderate COVID-19. Case reports described a clinical rebound syndrome whereby individuals experience a relapse of symptoms shortly after completing successful treatment. There is a lack of information on frequency of COVID-19 rebound after NM/r in routine clinical care, contributing factors, and clinical outcomes.

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Article Synopsis
  • Nirmatrelvir/ritonavir (NM/r) is an effective oral antiviral for treating mild-to-moderate COVID-19, but some patients experience a return of symptoms after treatment, known as clinical rebound.
  • A study of 268 adults revealed a 6% rate of COVID-19 rebound after NM/r treatment, primarily affecting females, individuals with co-morbidities, and those without prior infections.
  • The rebound occurs about 11 days after treatment and is usually mild, with few hospitalizations, indicating better outcomes than previously thought.
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  • There is evidence that some patients may get COVID-19 again 2 to 8 days after stopping a specific treatment called nirmatrelvir-ritonavir, and this can happen with other treatments too.
  • A review of various studies looked at how often this rebound happens with different treatments for COVID-19, including no treatment at all.
  • The findings showed that patients taking nirmatrelvir had a higher chance of getting the virus again compared to those who didn’t take any medication, but there wasn't a big difference with other medicines like molnupiravir.
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