TY - JOUR
T1 - Symptoms, Viral Loads, and Rebound among COVID-19 Outpatients Treated with Nirmatrelvir/Ritonavir Compared with Propensity Score-Matched Untreated Individuals
AU - Smith-Jeffcoat, Sarah E.
AU - Biddle, Jessica E.
AU - Talbot, H. Keipp
AU - Morrissey, Kerry Grace
AU - Stockwell, Melissa S.
AU - Maldonado, Yvonne
AU - McLean, Huong Q.
AU - Ellingson, Katherine D.
AU - Bowman, Natalie M.
AU - Asturias, Edwin
AU - Mellis, Alexandra M.
AU - Johnson, Sheroi
AU - Kirking, Hannah L.
AU - Rolfes, Melissa A.R.
AU - Olivo, Vanessa
AU - Merrill, Lori
AU - Battan-Wraith, Steph
AU - Sano, Ellen
AU - McLaren, Son H.
AU - Vargas, Celibell Y.
AU - Goodman, Sara
AU - Sarnquist, Clea C.
AU - Govindaranjan, Prasanthi
AU - Petrie, Joshua G.
AU - Belongia, Edward A.
AU - Ledezma, Karla
AU - Pryor, Kathleen
AU - Lutrick, Karen
AU - Bullock, Ayla
AU - Yang, Amy
AU - Haehnel, Quenla
AU - Rao, Suchitra
AU - Zhu, Yuwei
AU - Schmitz, Jonathan
AU - Hart, Kimberly
AU - Grijalva, Carlos G.
AU - Salvatore, Phillip P.
N1 - Publisher Copyright:
© 2024 Oxford University Press. All rights reserved.
PY - 2024/5/15
Y1 - 2024/5/15
N2 - 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.
AB - 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.
KW - SARS-CoV-2
KW - antiviral treatment
KW - rebound
KW - symptoms
KW - viral loads
UR - http://www.scopus.com/inward/record.url?scp=85182584414&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85182584414&partnerID=8YFLogxK
U2 - 10.1093/cid/ciad696
DO - 10.1093/cid/ciad696
M3 - Article
C2 - 37963102
AN - SCOPUS:85182584414
SN - 1058-4838
VL - 78
SP - 1175
EP - 1184
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 5
ER -