tetano
Editor, Senior Moderator
Clin Infect Dis
. 2023 Nov 14:ciad696.
doi: 10.1093/cid/ciad696. Online ahead of print. Symptoms, viral loads, and rebound among COVID-19 outpatients treated with nirmatrelvir/ritonavir compared to propensity score matched untreated individuals
Sarah E Smith-Jeffcoat[SUP] 1 [/SUP], Jessica E Biddle[SUP] 2 [/SUP], H Keipp Talbot[SUP] 3 [/SUP], Kerry Grace Morrisey[SUP] 4 [/SUP], Melissa S Stockwell[SUP] 5 6 7 [/SUP], Yvonne Maldonado[SUP] 8 [/SUP], Huong Q McLean[SUP] 9 [/SUP], Katherine D Ellingson[SUP] 10 [/SUP], Natalie M Bowman[SUP] 11 [/SUP], Edwin Asturias[SUP] 12 [/SUP], Alexandra M Mellis[SUP] 2 [/SUP], Sheroi Johnson[SUP] 2 [/SUP], Hannah L Kirking[SUP] 1 [/SUP], Melissa A R Rolfes[SUP] 2 [/SUP], Vanessa Olivo[SUP] 4 [/SUP], Lori Merrill[SUP] 4 [/SUP], Steph Battan-Wraith[SUP] 4 [/SUP], Ellen Sano[SUP] 7 13 [/SUP], Son H McLaren[SUP] 7 13 [/SUP], Celibell Y Vargas[SUP] 5 [/SUP], Sara Goodman[SUP] 8 [/SUP], Clea C Sarnquist[SUP] 8 [/SUP], Prasanthi Govindaranjan[SUP] 8 [/SUP], Joshua G Petrie[SUP] 9 [/SUP], Edward A Belongia[SUP] 9 [/SUP], Karla Ledezma[SUP] 10 [/SUP], Kathleen Pryor[SUP] 10 [/SUP], Karen Lutrick[SUP] 10 [/SUP], Ayla Bullock[SUP] 11 [/SUP], Amy Yang[SUP] 11 [/SUP], Quenla Haehnel[SUP] 11 [/SUP], Suchitra Rao[SUP] 12 [/SUP], Yuwei Zhu[SUP] 3 [/SUP], Jonathan Schmitz[SUP] 3 [/SUP], Kimberly Hart[SUP] 3 [/SUP], Carlos G Grijalva[SUP] 3 [/SUP], Phillip P Salvatore[SUP] 1 [/SUP]
Affiliations
Background: Nirmatrelvir/ritonavir (N/R) reduces severe outcomes among patients with COVID-19; however, rebound after treatment has been reported. We compared symptom and viral dynamics in community-based individuals with COVID-19 who completed N/R and similar untreated individuals.
Methods: We identified symptomatic participants who tested SARS-CoV-2 positive and were N/R eligible from a COVID-19 household transmission study: index cases from ambulatory settings and their households were enrolled, collecting daily symptoms, medication use, and respiratory specimens for quantitative PCR for 10 days, March 2022-May 2023. Participants who completed N/R (treated) were propensity score matched to untreated participants. We compared symptom rebound, viral load (VL) rebound, average daily symptoms, and average daily VL by treatment status measured after N/R completion or, if untreated, seven days after symptom onset.
Results: Treated (n=130) and untreated participants (n=241) had similar baseline characteristics. After treatment completion, treated participants had greater occurrence of symptom rebound (32% vs 20%; p=0.009) and VL rebound (27% vs 7%; p<0.001). Average daily symptoms were lower among treated participants compared to untreated participants without symptom rebound (1.0 vs 1.6; p<0.01), but not statistically lower with symptom rebound (3.0 vs 3.4; p=0.5). Treated participants had lower average daily VLs without VL rebound (0.9 vs 2.6; p<0.01), but not statistically lower with VL rebound (4.8 vs 5.1; p=0.7).
Conclusions: Individuals who completed N/R experienced fewer symptoms and lower VL but were more likely to have rebound compared to untreated individuals. Providers should still prescribe N/R, when indicated, and communicate possible increased rebound risk to patients.
Keywords: SARS-CoV-2; antiviral treatment; rebound; symptoms; viral loads.
. 2023 Nov 14:ciad696.
doi: 10.1093/cid/ciad696. Online ahead of print. Symptoms, viral loads, and rebound among COVID-19 outpatients treated with nirmatrelvir/ritonavir compared to propensity score matched untreated individuals
Sarah E Smith-Jeffcoat[SUP] 1 [/SUP], Jessica E Biddle[SUP] 2 [/SUP], H Keipp Talbot[SUP] 3 [/SUP], Kerry Grace Morrisey[SUP] 4 [/SUP], Melissa S Stockwell[SUP] 5 6 7 [/SUP], Yvonne Maldonado[SUP] 8 [/SUP], Huong Q McLean[SUP] 9 [/SUP], Katherine D Ellingson[SUP] 10 [/SUP], Natalie M Bowman[SUP] 11 [/SUP], Edwin Asturias[SUP] 12 [/SUP], Alexandra M Mellis[SUP] 2 [/SUP], Sheroi Johnson[SUP] 2 [/SUP], Hannah L Kirking[SUP] 1 [/SUP], Melissa A R Rolfes[SUP] 2 [/SUP], Vanessa Olivo[SUP] 4 [/SUP], Lori Merrill[SUP] 4 [/SUP], Steph Battan-Wraith[SUP] 4 [/SUP], Ellen Sano[SUP] 7 13 [/SUP], Son H McLaren[SUP] 7 13 [/SUP], Celibell Y Vargas[SUP] 5 [/SUP], Sara Goodman[SUP] 8 [/SUP], Clea C Sarnquist[SUP] 8 [/SUP], Prasanthi Govindaranjan[SUP] 8 [/SUP], Joshua G Petrie[SUP] 9 [/SUP], Edward A Belongia[SUP] 9 [/SUP], Karla Ledezma[SUP] 10 [/SUP], Kathleen Pryor[SUP] 10 [/SUP], Karen Lutrick[SUP] 10 [/SUP], Ayla Bullock[SUP] 11 [/SUP], Amy Yang[SUP] 11 [/SUP], Quenla Haehnel[SUP] 11 [/SUP], Suchitra Rao[SUP] 12 [/SUP], Yuwei Zhu[SUP] 3 [/SUP], Jonathan Schmitz[SUP] 3 [/SUP], Kimberly Hart[SUP] 3 [/SUP], Carlos G Grijalva[SUP] 3 [/SUP], Phillip P Salvatore[SUP] 1 [/SUP]
Affiliations
- PMID: 37963102
- DOI: 10.1093/cid/ciad696
Background: Nirmatrelvir/ritonavir (N/R) reduces severe outcomes among patients with COVID-19; however, rebound after treatment has been reported. We compared symptom and viral dynamics in community-based individuals with COVID-19 who completed N/R and similar untreated individuals.
Methods: We identified symptomatic participants who tested SARS-CoV-2 positive and were N/R eligible from a COVID-19 household transmission study: index cases from ambulatory settings and their households were enrolled, collecting daily symptoms, medication use, and respiratory specimens for quantitative PCR for 10 days, March 2022-May 2023. Participants who completed N/R (treated) were propensity score matched to untreated participants. We compared symptom rebound, viral load (VL) rebound, average daily symptoms, and average daily VL by treatment status measured after N/R completion or, if untreated, seven days after symptom onset.
Results: Treated (n=130) and untreated participants (n=241) had similar baseline characteristics. After treatment completion, treated participants had greater occurrence of symptom rebound (32% vs 20%; p=0.009) and VL rebound (27% vs 7%; p<0.001). Average daily symptoms were lower among treated participants compared to untreated participants without symptom rebound (1.0 vs 1.6; p<0.01), but not statistically lower with symptom rebound (3.0 vs 3.4; p=0.5). Treated participants had lower average daily VLs without VL rebound (0.9 vs 2.6; p<0.01), but not statistically lower with VL rebound (4.8 vs 5.1; p=0.7).
Conclusions: Individuals who completed N/R experienced fewer symptoms and lower VL but were more likely to have rebound compared to untreated individuals. Providers should still prescribe N/R, when indicated, and communicate possible increased rebound risk to patients.
Keywords: SARS-CoV-2; antiviral treatment; rebound; symptoms; viral loads.