With or without treatment, COVID-19 relapses seem like symptoms to some people

With researchers at the University of California San Diego School of Medicine,
ACTIV-2 studyIt is part of the US government’s response to COVID-19.

They sought to determine whether such relapses differed from relapses documented in people treated with Paxlovid, a phenomenon known as Paxlovid rebound.

Writing the October 27, 2022 issue
JAMA network openscientists tracked 13 defined COVID-19 symptoms for 29 days in 158 untreated study participants. They found that more than one-third of patients reported recurrence of symptoms afterward.

Davey Smith MD is Chief of Infectious Diseases and Global Public Health at the UC San Diego School of Medicine and an Infectious Disease Specialist at UC San Diego Health.

“It’s clear that COVID-19 comes and goes with or without treatment,” said the study’s first author.
Davey M. Smith, MDDirector of Infectious Diseases and Global Public Health at UC San Diego College of Medicine and an Infectious Diseases Specialist at UC San Diego Health.

In late 2021, the U.S. Food and Drug Administration issued Emergency Use Authorization for paxlovid, a combination of two oral antiviral drugs (nilmatrelvir and ritonavir) that has become a leading frontline treatment for COVID-19. Clinical trial data suggest that paxlovid significantly reduces the risk of serious illness, hospitalization and death.

However, treatment efficacy has proven to be temporary in some cases, with a minority of patients experiencing recurrence of COVID symptoms after a 5-day course of paxlovid treatment or SARS after a previous negative test. -I have tested positive for the CoV-2 virus.

Earlier this year, Smith and colleagues
study This suggests that drug resistance or immune impairment does not appear to be involved in the rebound of paxlobid and may be a result of inadequate exposure to the drug. Other studies have reported similar results.

“COVID rebound is a real phenomenon. It is complex, multifactorial, and its biological basis remains unknown. Further research is needed,” said Smith. “However, in this latest study, we wanted to see if a symptom rebound also occurred during the natural history of COVID-19.

Colorized scanning electron micrograph of cells infected with the Omicron strain of SARS-CoV-2 virions (pink) isolated from a patient sample.

To that end, we evaluated eligible participants in a 2020 clinical trial evaluating the safety and efficacy of an investigational drug to treat COVID-19. However, these study volunteers received a placebo. During the trial, participants completed daily symptom diaries, including several weeks after their COVID-19 symptoms first resolved. Twenty-eight days after enrollment in the study, 108 of 158 participants (68%) described complete resolution of their symptoms, while 48 participants (30% of the total group) subsequently Reported recurrence of at least one distinct symptom.

Most (85%) of participants with recurring symptoms described their symptoms as mild. 15 percent as moderate. Nothing serious. The most common recurrent symptoms were cough, fatigue, and headache. Eight of the 158 participants were hospitalized for their illness, none died, and none relapsed after achieving symptom resolution.

Co-authors are: Jonathan Z. Li, Harvard Medical School. Carlee Moser, Eunice Yeh, Michael D. Hughes, Harvard University. and Judith S. Currier and Kara W. Chu, UCLA.

Funding for this study came in part from the U.S. Government’s COVID-19 response and the National Institutes of Health (Grants UM1 AI068634, UM1 AI068636, and UM1 AI106701).

Disclosure: Smith has received compensation from Linear Therapies, Model Medicines, Kiadis Pharmaceuticals, Bayer Pharmaceuticals, Signant Health, Evidera, Fluxergy, VxBioscience and Pharma Holdings for consulting work other than the work submitted. Li has received grants from Merck outside of his submitted work. Currier received a fee from Merck for Advisory Board work other than submitted work. Chew has received research funding for her institution from Merck Sharp & Dohme and consulting services from Pardes Biosciences. She also has a patent pending for the ACTIV-2 COVID-19 acute and long-term symptom diary. These were developed with federal funding, so they will be available for free.