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

被引：19

作者：

Smith-Jeffcoat, Sarah E. ^{[1
]}

Biddle, Jessica E. ^{[2
]}

Talbot, H. Keipp ^{[3
]}

Morrissey, Kerry Grace

Stockwell, Melissa S. ^{[4
,5
,6
,7
]}

Maldonado, Yvonne ^{[8
]}

McLean, Huong Q. ^{[9
]}

Ellingson, Katherine D. ^{[10
]}

Bowman, Natalie M. ^{[11
]}

Asturias, Edwin ^{[12
,13
]}

Mellis, Alexandra M. ^{[2
]}

Johnson, Sheroi ^{[2
]}

Kirking, Hannah L. ^{[1
]}

Rolfes, Melissa A. R. ^{[2
]}

Olivo, Vanessa

Merrill, Lori

Battan-Wraith, Steph

Sano, Ellen ^{[7
]}

McLaren, Son H. ^{[7
]}

Vargas, Celibell Y. ^{[4
]}

Goodman, Sara ^{[8
]}

Sarnquist, Clea C. ^{[8
]}

Govindaranjan, Prasanthi ^{[8
]}

Petrie, Joshua G. ^{[9
]}

Belongia, Edward A. ^{[9
]}

Ledezma, Karla ^{[10
]}

Pryor, Kathleen ^{[10
]}

Lutrick, Karen ^{[10
]}

Bullock, Ayla ^{[11
]}

Yang, Amy ^{[11
]}

Haehnel, Quenla ^{[11
]}

Rao, Suchitra ^{[2
,13
]}

Zhu, Yuwei ^{[3
]}

Schmitz, Jonathan ^{[3
]}

Hart, Kimberly ^{[3
]}

Grijalva, Carlos G. ^{[3
]}

Salvatore, Phillip P. ^{[1
]}

机构：

[1] Centers Dis Control & Prevent, Coronavirus & Other Resp Viruses Div, 1600 Clifton Rd NE,MS H24-9, Atlanta, GA 30333 USA

[2] Ctr Dis Control & Prevent, Influenza Div, Atlanta, GA USA

[3] Vanderbilt Univ, Med Ctr, Nashville, TN USA

[4] Westat Corp, Rockville, MD USA

[5] Columbia Univ, Div Child & Adolescent Hlth, Dept Pediat, Vagelos Coll Phys & Surg, New York, NY USA

[6] Columbia Univ, Dept Populat & Family Hlth, Mailman Sch Publ Hlth, New York, NY USA

[7] New York Presbyterian Hosp, New York, NY USA

[8] Stanford Univ, Sch Med, Stanford, CA USA

[9] Marshfield Clin Res Inst, Marshfield, WI USA

[10] Univ Arizona, Coll Med, Tucson, AZ USA

[11] Univ North Carolina, Chapel Hill, NC USA

[12] Childrens Hosp Colorado, Aurora, CO USA

[13] Columbia Univ, Dept Emergency Med, Vagelos Coll Phys & Surg, New York, NY USA

来源：

CLINICAL INFECTIOUS DISEASES | 2024年 / 78卷 / 05期

关键词：

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

D O I：

10.1093/cid/ciad696

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

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.

引用

页码：1175 / 1184

页数：10