Some people who have infectious illnesses have a rebound of symptoms following clinical improvement. There has been some debate as to whether taking Paxlovid increases the risk of rebound in Covid 19 patients who are treated with it. This is the latest salvo. This summary is from Journal Watch.
Bottom line: If you are sick with Covid 19, older and at risk for progression to severe Covid 19, don’t let the fear of rebound symptoms dissuade you from taking Paxlovid if you have no other contraindications to taking it. However, this will not be the last we hear on this issue.
January 3, 2024
Is COVID-19 Rebound Related to COVID-19 Therapy?
Stephen G. Baum, MD, reviewing
CDC analyses of multiple studies found no statistically significant relation between incidence of COVID-19 rebound and previous treatment with antiviral drugs.
Use of nirmatrelvir/ritonavir (N/R; Paxlovid), the recommended treatment for mild-to-moderate COVID-19, has lowered rates of hospitalization and death. For patients already taking drugs with N/R contraindications, molnupiravir is recommended and has also reduced both outcomes. Still, uptake of these antivirals has fallen short of the hoped-for goal — and this lack of acceptance is thought to be due to public belief that COVID-19 rebound (recurrence of symptoms or a newly positive SARS-CoV-2 test after recovery) is related to such drugs.
Now, CDC has published two reports: A meta-analysis of data from seven studies comparing rebound rates with and without antiviral use, and a retrospective analysis of two placebo-controlled trials of N/R. Overall, the studies yielded no statistically significant evidence that treatment with any of the approved anti–COVID-19 drugs raised risk for symptomatic or viral rebound. When rebound did occur, it generally affected patients who were immunocompromised or who had significant comorbidities, and it was not associated with increased mortality or hospitalization.
Medical rumors die hard, and those surrounding the prevention and treatment of COVID-19 are no exception. However, for individuals who rely on data for decision making, these two studies provide ample evidence in favor of the currently approved drugs for mitigating severe SARS-CoV-2 infection without significantly increasing incidence of rebound, thereby diminishing the likelihood of hospitalization and death.
Smith DJ et al. SARS-CoV-2 rebound with and without use of COVID-19 oral antivirals. MMWR Morb Mortal Wkly Rep 2023 Dec 22; 72:1357. (https://doi.org/10.15585/mmwr.mm7251a1. opens in new tab)
Harrington PR et al. Evaluation of SARS-CoV-2 RNA rebound after nirmatrelvir/ritonavir treatment in randomized, double-blind, placebo-controlled trials — United States and international sites, 2021–2022. MMWR Morb Mortal Wkly Rep 2023 Dec 22; 72:1365. (https://doi.org/10.15585/mmwr.mm7251a2