Does Treatment with Nirmatrelvir/Ritonavir Raise Risk for COVID-19 Rebound?

In a community-based study, clinical and virologic rebound was more common in patients who received nirmatrelvir/ritonavir than in those who did not receive antivirals.

While symptomatic rebound after a 5-day course of nirmatrelvir/ritonavir (Paxlovid) has been reported, this phenomenon appears to occur infrequently and independently of antiviral administration (NEJM JW Infect Dis Jan 3 2024). Now, investigators for a prospective, multicenter, community-based study examined the frequency of symptomatic and virologic rebound in a cohort of patients with virologically documented infection who maintained daily diaries and swabs to assess SARS-CoV-2 viral load. Patients who received nirmatrelvir/ritonavir according to EUA guidelines were propensity-matched with those who did not receive the medication despite meeting the criteria for treatment.

Symptomatic rebound occurred in 32% of 130 patients who received ni…

Reviewing Author

Anna Wald, MD, MPH

Disclosures

Consultant/Advisory BoardAicuris; Bayer; GSK; Innovative Molecules; Merck; MAPP Biopharmaceutical (Safety Monitoring Committee)

RoyaltiesUpToDate

Grant/Research SupportNIH/National Institute of Allergy and Infectious Diseases; GSK; Moderna; Assembly Biomedical; Aicuris

Editorial BoardsSexually Transmitted Diseases; Sexually Transmitted Infections; Journal of Infectious Diseases

Leadership PositionsID Division Chiefs Community of Practice (At-Large Member)