Symptoms, Viral Loads, and Rebound among COVID-19 Outpatients Treated with Nirmatrelvir/Ritonavir Compared with Propensity Score-Matched Untreated Individuals

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

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Background. Nirmatrelvir/ritonavir (N/R) reduces severe outcomes from coronavirus disease 2019 (COVID-19); however, rebound after treatment has been reported. We compared symptom and viral dynamics in individuals with COVID-19 who completed N/R treatment and similar untreated individuals. Methods. We identified symptomatic participants who tested severe acute respiratory syndrome coronavirus 2-positive and were N/R eligible from a COVID-19 household transmission study. Index cases from ambulatory settings and their households contacts were enrolled. We collected daily symptoms, medication use, and respiratory specimens for quantitative polymerase chain reaction for 10 days during March 2022 - May 2023. Participants who completed N/R treatment (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 treatment completion or 7 days after symptom onset if untreated. 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 = .009) and VL rebound (27% vs 7%; P < .001). Average daily symptoms were lower among treated participants without symptom rebound (1.0 vs 1.6; P < .01) but not statistically lower with symptom rebound (3.0 vs 3.4; P = .5). Treated participants had lower average daily VLs without VL rebound (0.9 vs 2.6; P < .01) but not statistically lower with VL rebound (4.8 vs 5.1; P = .7). Conclusions. Individuals who completed N/R treatment experienced fewer symptoms and lower VL but rebound occured more often compared with untreated individuals. Providers should prescribe N/R, when indicated, and communicate rebound risk to patients.

Original languageEnglish (US)
Pages (from-to)1175-1184
Number of pages10
JournalClinical Infectious Diseases
Volume78
Issue number5
DOIs
StatePublished - May 15 2024

Keywords

  • SARS-CoV-2
  • antiviral treatment
  • rebound
  • symptoms
  • viral loads

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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