Paxlovid Rebound: Rare but real

“The rebound of Pax Rovid is realistic and not well understood,” he tweeted. Bob Wachter, MD, May 11th. “Urgent research and pt counseling are needed.”

Wachter’s tweet came as a word about possibilities Paxlovid Rebounds have begun to bounce around social and traditional media. Wachter, a professor and director of medicine at the University of California, San Francisco, has emerged as one of the leading social media voices on the COVID-19 pandemic.

Paxrovid rebound refers to the relapse of symptomatic COVID-19 a few days after taking a prescribed 5-day course of Pfizer’s oral antiviral drug and failing the test. No one knows why it happens.

Research results are slowly beginning to flow, showing that rebounds are extremely rare.Mayo Clinic researchers reported research result In the journal today Clinical infections Four of 483 (0.8%) of patients at high risk of experiencing severe COVID-19 treated with Paxlovid showed a median 9 days post-treatment with relapse of symptoms. All four were vaccinated.Researchers described the case as mild and successfully treated with additional COVID-19 therapy.

FDA authorities have acknowledged this issue.and Interview record Published on the FDA’s website in early May, Dr. John Farley, MD, Director of Infectious Diseases at the FDA’s Center for Drug Evaluation and Research, is a clinical trial supporting the authorities’ decision to issue an Emergency Use Authorization (EUA). We discussed about. ) For Paxlovid. 1% to 2% of study participants underwent one or more positive polymerase chain reaction (PCR) tests for the SARS-CoV-2 virus. This causes COVID-19 after test results that are negative or indicate an increase in the amount of SARS. -CoV-2.Farley said the rebound is not necessarily due to Paxlovid, as the same is true for people assigned to the placebo group.

CDC rang a chime on May 24th Advisory It admitted a case report of rebound. The CDC also stated that cases of rebound disease were mild. The advisory states that “the potential for infection during COVID-19 rebound has been described,” but it is also unclear whether the potential for infection during rebound disease is the same as at the time of the initial infection. I am saying.

Farley and others are paying attention to the benefits of Pax Rovid. Studies that led to the EUA showed that antiviral drugs reduced the risk of hospitalization or death in unhospitalized patients at high risk of developing severe cases of COVID-19 by 88%. However, the people enrolled in the study were not vaccinated. The news of Paxrovid’s rebound raised the question of whether antivirals could have different effects on vaccinated people.

Paxlovid consists of nirmatorelvir, which acts directly on the SARS-CoV-2 virus, and ritonavir, a reused HIV drug that enhances the efficacy of nirmatorelvir. As a convenient oral drug with excellent efficacy data, antiviral drugs are said to be an important weapon in the fight against COVID-19.

One of the suggested explanations for Paxrovid’s rebound is that the infection recurs after 5 days of treatment because the antiviral drug knocks down the viral load and the immune response to the virus is incomplete. Thing. Paul E. Sax, MD, MD, clinical director of the Infectious Diseases Division at Brigham and Women’s Hospital in Boston, said SARS-CoV-2 replication was elicited to some people and Pax Robin reduced it, but replication. Emerged the idea of ​​increasing. When the 5-day course is over, it will be up again.

Paxlovid’s rebound raised the question of how long COVID-19 people who took antiviral drugs should be quarantined. It is also uncertain whether Paxlovid’s second course can be used to treat rebound infections.Saxophone, writing NEJM journal watchRetreatment is permitted under the EUA and is justified for high-risk patients such as those with severe immunodeficiency. However, in a transcript posted on the FDA’s website, Farley said there was no evidence of benefit from long-term or repetitive treatment with Paxrovid. The CDC’s recommendations also state that there is no evidence of the benefits of additional treatment.