Experience Using Paxlovid for Patients With Coronavirus Disease 2019 in a Resource-Limited Emergency Department

Nene, Rahul V.; Navarro, Michael; Tomaszewski, Christian; Lafree, Andrew

doi:10.1016/j.annemergmed.2022.05.029

Cited by 1 publication

(1 citation statement)

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“…To date, the effect of NMV‐r has been evaluated in many randomized controlled trials (RCTs) and real‐world studies 27,31–34 . Phase 2‐3 double‐blind RCTs found that the incidence of COVID‐19‐related hospitalization or death by Day 28 was lower in the NMV‐r group than in the placebo group by 6.32 percentage points (95% confidence interval [CI], −9.04 to −3.59; p < 0.001; relative risk reduction, 89.1%) among symptomatic, unvaccinated, nonhospitalized adults at high risk for progression to severe COVID‐19 27 .…”

Section: Introductionmentioning

confidence: 99%

Coronavirus disease 2019 rebounds following nirmatrelvir/ritonavir treatment

Lai

Hsueh

2023

Journal of Medical Virology

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Nirmatrelvir/ritonavir (NMV‐r) is an effective anti‐SARS‐CoV‐2 agent and has been recommended in the treatment of nonhospitalized patients with COVID‐19. In rare occasions, some patients experience virologic and symptomatic rebound after initial resolution, which we call COVID‐19 rebound after NMV‐r. Although COVID rebound can also occur after molnupiravir treatment or even no antiviral treatment, we have more serious concern about the rebound after NMV‐r, which remains the most effective antiviral. Due to a lack of information about its frequency, mechanism, outcomes, and management, we conducted this review to provide comprehensive and updated information to address these questions. Based on the limited evidence, the incidence of COVID‐19 rebound after NMV‐r was less than 2%, and most cases developed 5–15 days after initiating NMV‐r treatment. Almost all reported cases had mild symptoms, and the clinical condition gradually subsided without additional treatment. Overall, the clinical outcome was favorable, and only a small number of patients required emergency department visits or hospitalization. Regarding virologic rebound, culturable SARS‐CoV‐2 with possible transmission was observed, so re‐isolation may be needed.

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Section: Introductionmentioning

confidence: 99%