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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 1 , Jessica E Biddle 2 , H Keipp Talbot 3 , Kerry Grace Morrisey 4 , Melissa S Stockwell 5 6 7 , Yvonne Maldonado 8 , Huong Q McLean 9 , Katherine D Ellingson 10 , Natalie M Bowman 11 , Edwin Asturias 12 , Alexandra M Mellis 2 , Sheroi Johnson 2 , Hannah L Kirking 1 , Melissa A R Rolfes 2 , Vanessa Olivo 4 , Lori Merrill 4 , Steph Battan-Wraith 4 , Ellen Sano 7 13 , Son H McLaren 7 13 , Celibell Y Vargas 5 , Sara Goodman 8 , Clea C Sarnquist 8 , Prasanthi Govindaranjan 8 , Joshua G Petrie 9 , Edward A Belongia 9 , Karla Ledezma 10 , Kathleen Pryor 10 , Karen Lutrick 10 , Ayla Bullock 11 , Amy Yang 11 , Quenla Haehnel 11 , Suchitra Rao 12 , Yuwei Zhu 3 , Jonathan Schmitz 3 , Kimberly Hart 3 , Carlos G Grijalva 3 , Phillip P Salvatore 1
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 1 , Jessica E Biddle 2 , H Keipp Talbot 3 , Kerry Grace Morrisey 4 , Melissa S Stockwell 5 6 7 , Yvonne Maldonado 8 , Huong Q McLean 9 , Katherine D Ellingson 10 , Natalie M Bowman 11 , Edwin Asturias 12 , Alexandra M Mellis 2 , Sheroi Johnson 2 , Hannah L Kirking 1 , Melissa A R Rolfes 2 , Vanessa Olivo 4 , Lori Merrill 4 , Steph Battan-Wraith 4 , Ellen Sano 7 13 , Son H McLaren 7 13 , Celibell Y Vargas 5 , Sara Goodman 8 , Clea C Sarnquist 8 , Prasanthi Govindaranjan 8 , Joshua G Petrie 9 , Edward A Belongia 9 , Karla Ledezma 10 , Kathleen Pryor 10 , Karen Lutrick 10 , Ayla Bullock 11 , Amy Yang 11 , Quenla Haehnel 11 , Suchitra Rao 12 , Yuwei Zhu 3 , Jonathan Schmitz 3 , Kimberly Hart 3 , Carlos G Grijalva 3 , Phillip P Salvatore 1
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.