Can Paxlovid treat prolonged covid? Oh New report suggests that it may help some patients, but it is unclear which patients may benefit.
The report, published Monday in the journal Communication Medicine, describes the cases of 13 long-term Covid patients who underwent extended courses of antiviral medication. The results were decidedly mixed: nine patients reported some improvement, but only five said it lasted. Four reported no improvement.
Perhaps more than anything else, the report emphasizes that nearly five years after the pandemic began, little is known about what can help the millions of long-term victims of Covid. . Although some people improve on their own or with various treatments and medications, no treatment has yet been widely successful.
“People with long-term Covid are desperate for treatments that can help,” said Alison Cohen, an epidemiologist at the University of California, San Francisco, who is an author of the new report and herself a long-term Covid survivor. are “There’s been a lot of research, but it’s progressing at a slow pace.”
Paxlovid, made by Pfizer, is considered a worrisome prospect because it can prevent severe disease during active Covid infection and because patients who have a five-day course during infection. It is less likely to develop prolonged covid later..
Also, a theory that may have led to some prolonged cases of Covid. Remains of the virus in the body suggests that an antiviral such as Paxlovid can eliminate these symptoms by killing the virus for a long time.
Last year, the first Randomized trial of Paxlovid for prolonged covid showed no benefit. Conducted at Stanford, it involved 155 patients who took the drug or a placebo for 15 days. While taking Paxlovid for this long was found to be safe, it didn’t benefit patients much: after ten weeks, the placebo and Paxlovid groups showed no significant difference in the severity of prolonged Covid symptoms.
Dr. Upender Singh, an infectious disease specialist and leader of the trial, said his findings and the new report raise “more questions to be answered,” mainly: Is Paxlovid for longer than 15 days or other drugs more effective? Can help be paired together? Does the effect vary depending on the type of symptoms or when the symptoms started?
“It’s very possible that within a long covid, there will be different types of disease,” said Dr. Singh, who is now chief of internal medicine at the University of Iowa. Paxlovid or other antivirals may help patients who are clearly determined to have lingering virus in their bodies, he said.
Akiko Iwasaki, an immunologist at Yale University, said scientists should not “throw in the towel” on the possibility of a long-term antiviral for Covid.
“If you look overall, you don’t see a difference between the placebo group, but these case reports show that there are people who really benefit, so we need to include those people. ” said Dr. Iwasaki, who is leading another randomized trial of Paxlovid, the results of which have yet to be published.
The next important steps will be to identify biomarkers in people whose long-term Covid symptoms improved with paxilvid and to see if other antivirals help different patients, he said.
The new report was not a clinical trial, but a collection of self-reports from 13 long-term Covid patients from around the country who had tried extended courses of Paxlovid. This is the first published case series of such patients, according to the authors, including Dr. Michael Peluso, an infectious disease physician at UCSF, and members of the Patient-Led Research Collaborative, a group of researchers who have long-term covid. There is also
The authors said that the patients’ experiences were too varied to obtain a consistent trajectory, but could provide clues for larger studies of different types.
The patients, aged between 25 and 55 years, were infected between March 2020 and December 2022. They experienced one or more of a range of symptoms, including fatigue. Gastrointestinal problems; cognitive problems such as brain fog; muscle pain; irregular heart rate; and a condition called post-exercise anxiety, in which physical or mental exertion causes setbacks.
As with the Stanford trial, most patients in the new report were vaccinated by the time they received Paxlovid. Their Paxlovid courses ranged from 7.5 days to 30 days. Most people tried it to get relief from their persistent long-Covid symptoms. Two patients with prolonged covid received extended courses of paxilvid when they were reinfected with the virus.
Dr. Cohen said most patients were also taking other medications or supplements, making it difficult to determine the specific effect of the drug. Still, some said Paxlovid helped them significantly.
Kate Leslie, 46, a social worker in Boulder, Colo., said she was healthy and athletic before her coronavirus infection in March 2022. Six weeks later, she said, she felt as if she had a concussion, which was having trouble thinking clearly. And find the words.
He developed postural orthostatic tachycardia syndrome, which includes irregular heart rate and blood pressure and occasional fainting. A longtime ultimate frisbee player and coach, she began experiencing profound fatigue and could barely lift her arms.
“It was like having concrete blocks on your body,” she said. “I couldn’t get out of bed. My husband had to wash and dry my hair and dress me.
After an antiviral she was prescribed for a flu infection, Tamiflu, alleviated some of her lingering Covid symptoms, Ms Leslie wondered if a Covid-related antiviral might help even more. Can, he said. In February 2023, he found a doctor to prescribe a 15-day course of Paxalwood.
After that, “I could feel my body recovering,” she said, “I started to get my energy back.”
About six months later, he got another 15-day course, which again helped, he said. She estimates that she can now function at about 85 percent of her pre-Covid level.
Ms. Leslie said, however, that some of her medical problems worsened after Paxlovid, including an immune system condition that causes allergies. Three other patients also reported bothersome problems after taking Paxlovid, including tingling and gastrointestinal discomfort.
Among those who saw no benefit to the drug was Julia Moore Vogel. Dr. Vogel, 39, a senior program director at Scripps Research, was an avid long-distance runner before contracting the coronavirus in July 2020. She now uses a wheelchair and lives mostly at home.
She and her daughter recently moved across the country from California to live with her parents in Schaghticoke, New York. We need more help at home,” she said. .
Dr Vogel, whose symptoms included fatigue, post-exercise sickness and migraines, started a 10-day course of Paxlovid in April 2023. “It didn’t affect me at all,” he said.
These days, she budgets her energy carefully, trying not to leave the house more than once a week. Migraine medications have provided some relief, she said, but other than that, “I’ve tried a lot of things, and basically nothing has helped me get better.”
Dr Cohen said the report reinforces the idea that there are many different causes and treatments for prolonged Covid.
“A really important question is who might benefit from an extended course of Paxlovid and why,” he said, “and if it does benefit some symptoms, which symptoms will it benefit?” Who benefits?”