Symptoms, Viral Loads, and Rebound Among Coronavirus Disease 2019 (COVID-19) Outpatients Treated With Nirmatrelvir/Ritonavir Compared With Propensity Score–Matched Untreated Individuals-Reference-Cited by-同舟云学术

Symptoms, Viral Loads, and Rebound Among Coronavirus Disease 2019 (COVID-19) Outpatients Treated With Nirmatrelvir/Ritonavir Compared With Propensity Score–Matched Untreated Individuals

Published:2023-11-14 Issue: Volume: Page:
ISSN:1058-4838
Container-title:Clinical Infectious Diseases
language:en
Short-container-title:

Author:

Smith-Jeffcoat Sarah E¹^ORCID,Biddle Jessica E²^ORCID,Talbot H Keipp³^ORCID,Morrissey Kerry Grace⁴^ORCID,Stockwell Melissa S⁵⁶⁷^ORCID,Maldonado Yvonne⁸^ORCID,McLean Huong Q⁹^ORCID,Ellingson Katherine D¹⁰^ORCID,Bowman Natalie M¹¹^ORCID,Asturias Edwin¹²^ORCID,Mellis Alexandra M²^ORCID,Johnson Sheroi²^ORCID,Kirking Hannah L¹^ORCID,Rolfes Melissa A R²^ORCID,Olivo Vanessa⁴,Merrill Lori⁴^ORCID,Battan-Wraith Steph⁴^ORCID,Sano Ellen⁷¹³^ORCID,McLaren Son H⁷¹³^ORCID,Vargas Celibell Y¹⁴,Goodman Sara⁸,Sarnquist Clea C⁸^ORCID,Govindaranjan Prasanthi⁸,Petrie Joshua G⁹^ORCID,Belongia Edward A⁹^ORCID,Ledezma Karla¹⁰,Pryor Kathleen¹⁰,Lutrick Karen¹⁰^ORCID,Bullock Ayla¹¹,Yang Amy¹¹,Haehnel Quenla¹¹,Rao Suchitra¹²^ORCID,Zhu Yuwei³,Schmitz Jonathan³,Hart Kimberly³,Grijalva Carlos G³,Salvatore Phillip P¹^ORCID

Affiliation:

1. Coronavirus and Other Respiratory Viruses Division, Centers for Disease Control and Prevention , Atlanta, Georgia , USA

2. Influenza Division, Centers for Disease Control and Prevention , Atlanta, Georgia , USA

3. Vanderbilt University Medical Center , Nashville, Tennessee , USA

4. Westat , Rockville, Maryland , USA

5. Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons , New York, New York , USA

6. Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA

7. New York-Presbyterian Hospital , New York, New York , USA

8. Stanford University School of Medicine , Stanford, California , USA

9. Marshfield Clinic Research Institute , Marshfield, Wisconsin , USA

10. University of Arizona College of Medicine , Tucson, Arizona , USA

11. University of North Carolina , Chapel Hill, North Carolina , USA

12. Children's Hospital Colorado , Aurora, Colorado , USA

13. Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons , New York, New York, USA

14. Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA

Abstract

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.

Funder

CDC

Trustees of Columbia University

Vanderbilt University Medical Center

RVTN

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

Link

https://academic.oup.com/cid/advance-article-pdf/doi/10.1093/cid/ciad696/53929004/ciad696.pdf

Reference23 articles.