Symptoms, viral loads, and rebound among COVID-19 outpatients treated with nirmatrelvir/ritonavir compared to propensity score matched untreated individuals

Details

• Alternative Title:
  Clin Infect Dis
• Personal Author:
  Smith-Jeffcoat, Sarah E. ; Biddle, Jessica E. ; Talbot, H. Keipp ; Morrisey, Kerry Grace ; Stockwell, Melissa S. ; Maldonado, Yvonne ; McLean, Huong Q. ; Ellingson, Katherine D. ; Bowman, Natalie M. ; Asturias, Edwin ; Mellis, Alexandra M. ; Johnson, Sheroi ; Kirking, Hannah L. ; Rolfes, Melissa A.R. ; Olivo, Vanessa ; Merrill, Lori ; Battan-Wraith, Steph ; Sano, Ellen ; McLaren, Son H. ; Vargas, Celibell Y. ; Goodman, Sara ; Sarnquist, Clea C. ; Govindaranjan, Prasanthi ; Petrie, Joshua G. ; Belongia, Edward A. ; Ledezma, Karla ; Pryor, Kathleen ; Lutrick, Karen ; Bullock, Ayla ; Yang, Amy ; Haehnel, Quenla ; Rao, Suchitra ; Zhu, Yuwei ; Schmitz, Jonathan ; Hart, Kimberly ; Grijalva, Carlos G. ; Salvatore, Phillip P.
• Description:
  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.
  
  
• Subjects:
  Adolescent Child Child, Preschool Clinical Trials As Topic Female Humans Infant Infant, Newborn Information Storage And Retrieval Male Neoplasms Patient Selection Registries Young Adult

  More +
• Source:
  Clin Infect Dis. 78(5):1175-1184
• Pubmed Central ID:
  PMC11090981
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/ ; U10 CA180886/CA/NCI NIH HHSUnited States/ ; U10 CA180899/CA/NCI NIH HHSUnited States/
• Volume:
  78
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:a36ec3f032ead5500c55093b9d36fa05c6fa4c1966ce95e44bef55dece6b4ec3
• Download URL:
  https://stacks.cdc.gov/view/cdc/156364/cdc_156364_DS1.pdf
• File Type:
  [PDF - 1.03 MB ]