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Nirmatrelvir-ritonavir (Paxlovid) did not reduce the odds of developing long COVID in vaccinated, non-hospitalized adults, survey data showed.
About 16% of those treated with nirmatrelvir-ritonavir during acute infection with SARS-CoV-2 self-reported long COVID symptoms that persisted for 3 months or longer after infection, compared with 14% of those who were not treated with the medication (P=0.310), noted Matthew Durstenfeld, MD, of Zuckerberg San Francisco General Hospital, and colleagues in the Journal of Medical Virology.
Commonly reported symptoms of long COVID included fatigue, shortness of breath, confusion, headache, and altered taste and smell.
“The COVID pandemic is not over, and there are no proven treatments for long COVID,” Durstenfeld told MedPage Today in an email. “Prescribing Paxlovid does not eliminate the risk of long COVID even in the Omicron era — therefore, masks, indoor air purification, and physical distancing are still relevant prevention strategies.”
The survey data also showed a high rate of rebound among participants who took nirmatrelvir-ritonavir. About 21% of participants who had symptomatic improvement with the agent went on to report rebound symptoms. Also, nearly 26% of patients who completed treatment and tested negative for SARS-CoV-2 reported a subsequent positive antigen test, indicating rebound.
But people who reported rebound symptoms or tested positive didn’t report significantly more long COVID symptoms. Of those with rebound symptoms, 10.8% reported one or more long COVID symptoms, compared with 8.3% without rebound symptoms (P=0.33).
“People who are vaccinated can still get long COVID even if they take Paxlovid, but rebound doesn’t seem to be concerning as a warning sign that someone is at higher risk [for long COVID],” Durstenfeld explained.
These findings come on the heels of other data suggesting that nirmatrelvir-ritonavir may offer some protection against long COVID, at least in some age groups. A retrospective analysis of Veterans Affairs data found that use of nirmatrelvir-ritonavir in older adults with risk factors for severe disease was associated with a roughly 25% lower risk of developing a post-COVID condition. A large case-control study from the CDC found that in adults ages 50 and up, the risk of post-COVID conditions was also modestly lower. Also, investigators are studying whether nirmatrelvir-ritonavir could be an effective treatment for long COVID.
The study was part of the online global survey-based COVID-19 Citizen Science study, enrolling over 100,000 participants. This sub-study examined data of nearly 4,700 participants who were vaccinated against SARS-CoV-2, were not pregnant or hospitalized, and who reported their first SARS-CoV-2 positive test between March 2022 and August 2022. Of these, approximately 21% reported being treated with nirmatrelvir-ritonavir. As expected, those treated with the medication were older and had more comorbidities. Approximately 35% of treated and untreated individuals provided responses to a survey on long COVID. In a survey on rebound, 666 of nirmatrelvir-ritonavir-treated participants responded.
Limitations of the study included its observational design and reliance on patient self-reporting of treatment, testing, and symptoms, the authors noted. Also, the survey did not include objective measures of post-COVID outcomes or all long COVID-19 symptoms.
Katherine Kahn is a staff writer at MedPage Today, covering the infectious diseases beat. She has been a medical writer for over 15 years.
Disclosures
The COVID-19 Citizen Science Study is supported by the Patient-Centered Outcomes Research Institute and the Bill and Melinda Gates Foundation.
Durstenfeld is supported by the National Institutes of Health/National Heart, Lung, and Blood Institute; one co-author reported a financial relationship with AstraZeneca and Gilead Sciences.
Primary Source
Journal of Medical Virology
Source Reference: Durstenfeld MS, et al. “Association of nirmatrelvir for acute SARS-CoV-2 infection with subsequent long COVID symptoms in an observational cohort study” J Med Virol 2024; DOI: 10.1002/jmv.29333.
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