Study observes virologic rebound in 20% of COVID-19 patients treated with nirmatrelvir-ritonavir

An observational study of patients being treated for acute COVID-19 in a multicenter health care system observed virologic rebound in about 20 percent of patients treated with nirmatrelvir-ritonavir (N-R) versus about 2 percent of those who did not receive treatment. The findings are published in Annals of Internal Medicine.

N-R is an oral antiviral widely used in the United Sates to reduce the incidence of hospitalization and death among individuals with mild to moderate COVID-19. Soon after its adoption into clinical care, a clinical and virologic rebound phenomenon was reported, but data are conflicting about how common it is.

Researchers from Massachusetts General Hospital and Brigham and Women's Hospital studied 127 patients with acute COVID-19 to compare the frequency of virologic rebound in patients with (n=72) and without (n=55) N-R treatment. The study outcome was viral rebound within 3 weeks of an initial positive test, defined as either a positive SARS-CoV-2 viral culture following a prior negative culture or sustained elevated viral load after a prior decline. With frequent monitoring by both PCR and viral culture during the acute stages of COVID-19, the data showed that virologic rebound with replication-competent prolonged viral shedding occurred in approximately 1 in 5 individuals taking N-R. Only 1 untreated patient experienced virologic rebound. People who rebounded shedded live virus for a median of 14 days versus less than 5 dyas in those who did not. A regression model showed a trend towards higher rates of virologic rebound with earlier N-R initiation after the date of diagnosis and with earlier N-R initiation after the onset of symptoms. The researchers noted that compared with untreated individuals, those taking N-R were older, had received more COVID-19 vaccinations, and were more often immunosuppressed.

According to the study authors, these findings should be factored into consideration when weighing the benefits and risks of N-R treatment in patients at low risk for severe disease. Still, for patients at moderate to high-risk for severe COVID-19, the clinical benefits associated with N-R use are well established.

Source:
Journal reference:

Edelstein, G. E., et al. (2023) SARS-CoV-2 Virologic Rebound With Nirmatrelvir–Ritonavir Therapy. Annals of Internal Medicine. doi.org/10.7326/M23-1756.

Comments

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
Post a new comment
Post

While we only use edited and approved content for Azthena answers, it may on occasions provide incorrect responses. Please confirm any data provided with the related suppliers or authors. We do not provide medical advice, if you search for medical information you must always consult a medical professional before acting on any information provided.

Your questions, but not your email details will be shared with OpenAI and retained for 30 days in accordance with their privacy principles.

Please do not ask questions that use sensitive or confidential information.

Read the full Terms & Conditions.

You might also like...
Catholic hospital offered bucket, towels to woman it denied an abortion, California AG said