Recovery of COVID-19 after treatment with Paxlovid is likely due to insufficient exposure to the drug

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COVID-19 rebound“The recurrence of symptoms experienced by some patients treated with Paxlovid may actually be due to underexposure to the drug, according to a recent study published in Clinical infectious diseases.

Recently, the Centers for Disease Control and Prevention (CDC) issued a medical advisory warning people about a “COVID-19 rebound” where symptoms of COVID infection return in some patients after a course of treatment with Paxlovid. Paxlovid is currently the leading oral drug used to prevent severe cases of COVID-19 in high-risk patients, the researchers said.

“Paxlovid’s goal is to prevent serious illness and death, and so far, none of those who get sick again have required hospitalization, so it’s still doing its job,” Senior Author Davey M. Smith, MD, Head of Infectious Diseases diseases. and Global Public Health at UC San Diego School of Medicine, and an infectious disease specialist at UC San Diego, the press release said.

Researchers at the UC San Diego School of Medicine assessed one patient who suffered a “Covid-19 rebound” after treatment with Paxlovid. They found that recurrence of COVID symptoms in a patient after taking Paxlovid was not caused by developed resistance to the drug or impaired immunity against coronavirus, but was due to insufficient amount or exposure to the drug, according to the authors of the study.

FILE - In this photo provided by Pfizer, a lab technician visually inspects samples of COVID-19 Paxlovid tablets in Freiburg, Germany, in December 2021.  The researchers found that the patient's relapse of COVID symptoms after taking Paxlovid was not due to developed drug resistance or impaired immunity against the coronavirus, but was due to insufficient amounts or exposure to the drug.

FILE – In this photo provided by Pfizer, a lab technician visually inspects samples of COVID-19 Paxlovid tablets in Freiburg, Germany, in December 2021. The researchers found that the patient’s relapse of COVID symptoms after taking Paxlovid was not due to developed drug resistance or impaired immunity against the coronavirus, but was due to insufficient amounts or exposure to the drug.
(AP)

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“Our main concern was that the coronavirus could develop resistance to Paxlovid, so finding that it didn’t was a huge relief,” first author Aaron F. Karlin, MD, assistant professor at UC San Diego School of Medicine . said in the release.

The researchers isolated the SARS-CoV-2 BA.2 virus from a patient with a relapse of COVID-19 and tested whether he had developed drug resistance. The team led by Smith found that after treatment with the drug, the virus was still susceptible to Paxlovid and did not show any mutations that reduce the drug’s effectiveness.

The researchers also took a sample of the patient’s plasma and noted that antibodies were still effective in preventing virus entry and infection of new cells. They said this suggested that a weakened immune system could be ruled out as a contributing factor to disease recurrence.

A driver places a swab into a vial at a free COVID-19 testing site in the parking lot of Mercy Fitzgerald Hospital in Darby, Pennsylvania Thursday, January.  October 20, 2022.  The researchers also took a sample of the patient's plasma and noted that the patient's antibodies were still effective in preventing the virus from entering and infecting new cells.

A driver places a swab into a vial at a free COVID-19 testing site in the parking lot of Mercy Fitzgerald Hospital in Darby, Pennsylvania Thursday, January. October 20, 2022. The researchers also took a sample of the patient’s plasma and noted that the patient’s antibodies were still effective in preventing the virus from entering and infecting new cells.
(AP Photo/Matt Rourke, file)

California researchers concluded that the relapse of COVID-19 after a course of treatment with Paxlovid is likely due to insufficient exposure to the drug. The authors further explained that this means that the infected cells are not receiving enough of the drug to stop the virus from replicating, either because the drug is metabolized too quickly in some patients or because the drug needs to be taken for a longer time.

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Karlin said in a press release that he hopes doctors can check whether patients need longer course of treatment with Paxlovid or get a combination of medications.

The authors said in the release that Paxlovid users should be aware of the risk of symptoms recurring and take precautions such as wearing masks and quarantine if symptoms return.

Information signs in a retail store in Buffalo Grove, Illinois, Thursday, February.  10, 2022. The authors said in a release that Paxlovid users should be aware of the risk of symptoms recurring and take precautions such as wearing masks and quarantine if symptoms return.

Information signs in a retail store in Buffalo Grove, Illinois, Thursday, February. 10, 2022. The authors said in a release that Paxlovid users should be aware of the risk of symptoms recurring and take precautions such as wearing masks and quarantine if symptoms return.
(AP images)

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The researchers also noted that further research is needed to see how common this type of rebound occurs and which patients are most vulnerable.

“We just need to understand why some patients rebound and others don’t. More research needed to help us adjust treatment plans as needed,” Smith said in a press release.