Mysterious Phenomenon: Patients Report Rebound of COVID-19 Symptoms After Taking the Antiviral Drug Paxlovid

Twitter and Reddit are full of patients and doctors who share their experiences and hypotheses over the past few days, including John Donoghue, 71-year-old Honorary Professor of Physics in Amherst.

“There were three cases with the same pattern at home,” Donoghue said in an interview.

Donohue, his wife, and her 95-year-old mother were all infected with COVID last month. All three received Paxlovid, felt better, and had a negative 4-5 day rapid test.After that, their symptoms returned and each one It showed positive again.

“The second symptom was mild,” said Donoghue. “In a way, I feel Paxlovid did the job. It removed the extreme symptoms of the first round and alleviated them very quickly in all three cases.”

Paxlovid, Allow emergency use Federal regulatory approval in late December is home treatment prescribed with the first signs of infection in patients at high risk of serious COVID complications. Treatment consists of a series of 3 tablets taken twice daily for 5 days.

In its clinical trial, Pfizer reported an 89% reduction in COVID-related hospitalization or death from any cause in patients receiving Paxrovid within 3 days of symptoms compared to patients receiving placebo. ..

The pill is initially Difficult to find due to lack of supply For some, it’s more widely available than it is today. Doctors welcome antivirals as an irreplaceable treatment and prevent vulnerable people from developing life-threatening complications.

However, while some infectious disease experts praise the benefits of Paxrovid, they are concerned that the rebound that the patient sees or hears may indicate the patient after completing treatment. doing. others.

“Is it infectious even if I have a rebound after 12 days and I’m back at work and not wearing a mask?” Catherine, an assistant professor at Harvard Medical School and an infectious disease specialist at the Beth Israel Dikones Medical Center. Dr. Stephenson said. “If a rapid antigen test is positive, there is a significant amount of virus, and probably an infectious amount,” she said.

Stevenson Why study some people It is infected with COVID at home, but not at other homes.She is now Volunteer registration In the study, she also said she hopes to find out why some patients taking Paxrovid get sick again.

According to Stevenson, the project frequently uses PCR nasal tests to test volunteers, and scientists scrutinize the genomic information of these samples to see if the virus is resistant to Paxlovid or if the patient is COVID. You can quickly determine if you have been infected with another variant of.

Pfizer, the leading pharmaceutical manufacturer of Paxlovid, Documents submitted last fall “Several subjects appeared to rebound to SARS-CoV-2RNA levels around day 10 or 14,” but “currently there is no clear signal,” the virus showed resistance. One of Paxlovid’s key components to federal regulators for emergency use authorization. According to the document, Pfizer will continue to analyze the data.

In a statement to Globe, the company said: It is not resistant to Paxlovid and is very confident in its clinical efficacy. “

Dr. Michael Charnes, Chief Staff of VA Boston Healthcare Systems, recently completed a detailed study of one patient. Experienced a rebound After taking Paxlovid.

He sequenced three nasal swabs from the patient and tested the patient for batteries for other respiratory illnesses. Charness concluded that the virus was not resistant to Paxlovid and that the patient was not infected with other respiratory viruses or other variants of COVID. Rather, he concluded that some patients may require a longer course of treatment for the immune system in order to initiate a strong defense.

“Literally, Pax Rovid is a cat, it suppresses the virus, and when the cat is gone, the mouse comes out to play,” Charnes said.

“Paxlovid works really well while there, and for many people can eliminate the virus in a single stage of infection,” he said. “But for some people, they can’t get rid of it, maybe because it takes a while to boost their immunity. [all the virus] And Paxlovid is no longer helpful. “

Charnes said his study has been reviewed by medical journals and has not yet been published.

Dr. Paul Sachs, clinical director of the infectious disease department at Brigham and Women’s Hospital, said he was hearing from patients about the issue.

“At least those who have recovered clinically after taking Paxlovid should not ignore their symptoms when they return,” Sax said. “They should think of this as a recurrence of COVID, and then [test] Again myself. “

At this time, there is little scientific data on the rebound phenomenon of Paxrovid, and sax and other infectious disease experts have come to say that they do not know the best approach to handle such cases.

He said the issue was not addressed in either Paxrovid’s clinical trials or its treatment guidelines.

However, Sax said that if the patient rebounds after the first course, it “intuitively makes sense” to re-treat the patient on the second course of Paxrovid.

“It’s what I recommend to anyone who has it,” he said.

Meanwhile, Professor Donohue, who was hit by a COVID rebound with his wife and mother-in-law earlier this month, was so worried about their experience and worried about others that he contacted Pfizer from an online site for a case. Reported. ..

“They mailed me a questionnaire asking for details,” he said.

He said his family doctor did not recommend Paxlovid’s second round, but he also believes he and his family have finally defeated the virus.

His mother-in-law is still very tired and his wife continues to suffer from cold-like symptoms, but all three have recently been tested negative.

“The second round was calm,” he said. “We feel almost okay.”

Keirazar can be reached at [email protected] Follow her on Twitter @GlobeKayLazar..