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What is Pax Lovid’s rebound?

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When President Joe Biden was diagnosed with COVID, he Oral treatment with the antiviral drug paxlovid almost immediately. But four days after ending the Pax Lovid administration with negative results, Biden tested positive for COVID again but had no symptoms of the disease. The most notable example of what we call Anthony Fauci, the president’s chief medical adviser, has also experienced it. This condition has been reported in a small number of people receiving antiviral medications and is still under active research.

Scientific American We talked to an infectious disease expert about what the phenomenon is, how common it is, and what to do if you get infected.

What is Pax Robid?

Paxlovid is an oral antiviral drug taken as 3 tablets daily for 5 days. Manufactured by Pfizer, the drug is prescribed to people who have COVID and are at risk of serious illness. This includes those who have not been vaccinated, the elderly, or those with other medical conditions ranging from diabetes to cancer. Two of the three tablets are nirmatrelvir, a drug that targets an enzyme specific to the virus that causes COVID and inhibits its replication. The third pill is ritonavir, a drug originally developed to help treat HIV/AIDS, which increases levels of the first drug by slowing its breakdown in the body.

Davey Smith, director of infectious diseases and global public health at the University of California, San Diego, said: This includes “how vaccines are developed, how therapeutics are developed, how tests are conducted, how epidemiology is conducted,” he says.

Clinical trials have shown that paxlovid has been very successful in alleviating serious illness. In the group that received the drug, he had 89% fewer hospitalizations and deaths from COVID compared to the group that received the placebo sugar pills.

To ensure people have access to life-saving medicine, the Biden-Harris administration Test to Treat Program Enable anyone to be tested for COVID and receive Paxlovid in one trip to a pharmacy or treatment center.

What is Pax Rovid Rebound?

The CDC defines a rebound of paxlovid as when a patient develops symptoms of COVID again or tests positive after a previously negative test after receiving a complete five-day course of treatment. In this classification, upon rebound, “virus without symptoms, symptoms without virus, and that he could have the two together,” Smith says. He added that he was a little offended by the catch-all classification of “rebound” because “rebound” in virology is when the virus reappears in measurable amounts.

A clinical trial from Pfizer reported that 1% to 2% of people who received the drug tested positive for COVID after completing a course of paxlovid. They recovered from their illness. However, these rebounds were not statistically different from those experienced by COVID patients receiving placebo.

“By definition of the study, the reappearance of symptoms on a positive test is ‘syndromic’. [Paxlovid] It rebounds,” said Amy Barczak, an infectious disease physician and COVID researcher at Massachusetts General Hospital. “A positive test and no symptoms (something no one asked for) is ‘asymptomatic paxlovid rebound’.”

Adi Shah, an infectious disease specialist at the Mayo Clinic in Minnesota, said distinguishing between a true rebound in symptoms and a very slow improvement in symptoms after starting paxlovid is a consideration in patients. explained as another complicating factor. Clinically, this is an important difference because it could change the way people decide to isolate. To say exactly how many people experienced Pax Lovid’s rebound, we need to pinpoint it.

“The drug works in some people’s situations if the patient needs it.” [having] I will rebound,” says Smith. “Clinical trials have made it very clear that this is an excellent drug for keeping people out of hospital and out of death. So don’t be afraid of a rebound.”

Who is experiencing a Pax Lovid rebound and how often?

“among us [work]being older and having other risk factors, such as diabetes, heart disease, kidney disease, or certain types of cancer, increases your risk of rebound,” says Shah. Same as COVID risk factors.

Unfortunately, as mentioned above, it’s difficult to know exactly how often Pax Lovid’s rebounds will occur, since “rebound” must be defined uniformly first. Barczak estimated the percentage of people who would be experiencing this phenomenon if the rebound was classified as only a recurrence of symptoms or as multiple negative tests followed by multiple positive tests. explained that may change. Nonetheless, she still estimates that the rebound associated with the re-emergence of the virus is higher than reported in the first Pfizer clinical trial. Somewhere between 10 percent. [of people taking Paxlovid experience rebound],” she says. [know] accurately. “

In a recently published retrospective review of Mayo Clinic patients, Dr. Shah found: About 1% of Paxlovid users rebound, which is consistent with Pfizer’s clinical trials. But based on discussions he’s had with patients and other doctors since then, “I think the actual rate he could be 5 to 10 percent higher,” he says.

Shah said it’s difficult to pinpoint exactly how many people may be experiencing a rebound right now. , the symptoms recur. ‘ It’s difficult to do retroactively, because the clinic must have already collected all that information. It’s also difficult to do proactively because patients may not know they’ve rebounded, so they may not have tested for COVID or told anyone they’ve rebounded.

Barzcak points out that doctors and researchers have only recently started enrolling Paxlovid users in rebound studies. “It takes a while to actually enroll people in these prospective studies,” she explains. Once these findings are published, scientists will have a better idea of ​​how many people have actually experienced the phenomenon.

What should I do if I have a Pax Rovid rebound?

“I would like to emphasize that even with the rebound, it is still a good result,” says Shah. In general, “she does not need additional COVID treatment, does not require hospitalization, and does not experience high mortality or morbidity.”

However, it is still important to isolate after rebounding. “I think it’s very likely that the subset of individuals who had rebound symptoms after Paxlovid, but probably not everyone, would become newly infected during the rebound period,” Barczak said. team a nose sample was taken From the seven individuals experiencing rebound symptoms, three were able to culture the virus, suggesting that those individuals could infect others. “People need to be aware that they can be infected,” she says, even though the virus is small. Mask, and check.”

In addition to isolating and masking, it’s important to tell your doctor that you’re experiencing COVID symptoms again. “People undergoing certain types of chemotherapy, [those with] Certain immunosuppressive conditions pose the highest risk of serious illness, says Smith, so “you should talk to your doctor about it.” Those are the people he usually treats for rebounds on Pax Lovid’s second course. Some experts disagree that a second course of Paxlovid is justified in rebound cases.

What caused Pax Lovid’s rebound?

Some patients may experience a rebound because they are not receiving enough doses of nirmatrelvir, part of Paxlovid, which targets the COVID enzyme. Ritonavir is part of the treatment regimen because there is It is not the result of the virus acquiring resistance to medicine. He hypothesizes that people in the “real world” might decide to skip taking because paxlovid can make food taste bad. We may be some of the few people who do not experience adequate rates of drug release with the combination of vir and ritonavir. Dr. Smith said ongoing research really needs to focus on the idea that some patients may not have been exposed to the correct dosage of paxlovid. thinking about.

As scientists continue to learn more about Pax Lovid’s rebound, all doctors Scientific American He emphasized that he will continue to prescribe paxlobid to patients who need it. “Paxrovid can still be used effectively,” he says Barczak. “And by masking and testing and isolating when a rebound occurs, we can protect each other.”

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