Paxlovid Raised Risk for Virologic Rebound and Shedding

In an observational cohort study, virologic rebound occurred in about 20% of patients who received Paxlovid and <2% of those who did not.

The FDA's emergency use authorization of nirmatrelvir-ritonavir (Paxlovid) in December 2021 (NEJM JW Infect Dis Dec 29 2021 and FDA 2021 Dec 22; [e-pub]) was soon followed by reported rebound of positive SARS-CoV-2 tests and recrudescent symptoms. NIH's COVID-19 treatment guidelines note that, although the frequency and clinical implications of viral rebound (VR) are unclear, progression to more-severe symptoms does not seem to be associated with the phenomenon; thus, treatment with Paxlovid should not necessarily be deferred.

Now, a prospective cohort study using serial nasopharyngeal swabs from patients with COVID-19 who did or did not receive Paxlovid provides further information about VR, defined as: 1) a positive viral culture after a p…

Reviewing Author

Daniel Kaul, MD

Disclosures

Grant/Research SupportNobelpharma; Pfizer

Leadership Positions in Professional SocietiesAmerican Society of Transplantation (Program Committee)

Daniel Kaul, MD

Disclosures

Grant/Research SupportNobelpharma; Pfizer

Leadership Positions in Professional SocietiesAmerican Society of Transplantation (Program Committee)

Paxlovid Raised Risk for Virologic Rebound and Shedding

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Reviewing Author