Can Paxlovid treat long-term Covid? A new report suggests it may work for some patients, but it's still unclear which patients it will work for.
The report, published Monday in the journal Communication Medicine, describes the cases of 13 coronavirus patients who received long-term treatment with antiviral drugs. The results were clearly mixed. Nine patients reported some improvement, but only five said it was sustained. Four people reported no improvement at all.
Perhaps most of all, the report shows that nearly five years after the pandemic began, little is still known about what can help the millions of people suffering from prolonged COVID-19 infections. Emphasized. Although some people improve on their own or with various treatments and medications, no treatment has yet proven to be widely successful.
“People who have had long-term COVID-19 are in desperate need of helpful treatments,” said the new report's author, a professor at the University of California, San Francisco, who himself has had long-term COVID-19. says epidemiologist Alison Cohen. “A lot of research has been done, but progress is still slow.”
Paxlobid, made by Pfizer, is attractive because it can prevent severe illness during an active coronavirus infection, and patients who take the five-day course while infected are less likely to develop the coronavirus long term. It is considered a promising prospect.
Additionally, the theory that some long-term COVID-19 infections may be caused by virus persistence in the body suggests that antiviral drugs like paxlobid could counteract these symptoms by killing off residual virus. It suggests sex.
The first randomized trial of Paxlovid against long Covid last year found no effect. The study, conducted at Stanford University, involved 155 patients who took the drug or a placebo for 15 days. Taking paxlobid for that period of time was found to be safe, but did not help the patient much. After 10 weeks, there was no significant difference in the severity of long-term coronavirus symptoms between the placebo and paxlobid groups.
Dr. Upinder Singh, an infectious disease expert and leader of the trial, said the results and the new report mainly raised “further questions to answer”: Paxlobid should be taken for more than 15 days or Is it effective when used in combination with other drugs? Do the effects differ depending on the type of symptoms and when the symptoms started?
Dr. Singh, who is currently the chief of internal medicine at the University of Iowa, said, “It is very likely that many different types of illnesses will emerge as a result of the long COVID-19 pandemic.” Paxlobid and other antiviral drugs may help patients who have a clear indication that the virus remains in their body, she said.
Yale University immunologist Akiko Iwasaki said scientists should not “abandon” the possibility of antiviral drugs for long-term COVID-19 infections.
“Overall, we don't see a difference between the placebo groups, but these case reports show that there are people who really benefit, so we're focusing on those people.” “We need to guess,” Dr. Iwasaki said. He led another randomized trial of paxrovid, but the results have not yet been published.
He said an important next step will be to identify biological markers in people whose long-term coronavirus symptoms improve with paxlobid, and to see whether other antiviral drugs are effective in different patients. He said it was true.
The new report was not a clinical trial, but instead compiled self-reports from 13 coronavirus patients across the country who tried long-term treatment with paxlobid. According to the authors, who include Dr. Michael Peluso, an infectious disease physician at UCSF, and members of the Patient-Initiated Research Collaborative, a group of researchers who have also been infected with COVID-19, This is the first time that a series of cases has been made public.
The authors said patient experiences are too diverse to draw a consistent trajectory, but the diversity could provide clues for larger studies.
The patients ranged in age from 25 to 55 years old and were infected between March 2020 and December 2022. They experienced one or more of a variety of symptoms, including fatigue. Gastrointestinal problems. Cognitive problems like brain fog. Muscle pain. Irregular heart rate. The other is a condition called post-exertional malaise, where physical or mental exertion causes a setback.
As with the Stanford clinical trial, most of the patients in the new report had been vaccinated by the time they took paxlobid. Their Paxlovid courses ranged from 7.5 days to 30 days. Most people tried it to relieve lingering coronavirus symptoms. Two patients with long-term COVID-19 infections received extended doses of paxlobid when they were reinfected with the virus.
Most patients also take other drugs or supplements, making it difficult to determine the specific effects of those drugs, Dr. Cohen said. Still, some people say Pax Lovid has helped them a lot.
Kate Leslie, 46, a social worker in Boulder, Colorado, said she was healthy and athletic before contracting the coronavirus in March 2022. Six weeks later, he said he felt like he had a concussion and had trouble thinking clearly. and find the words.
She developed postural orthostatic tachycardia syndrome with symptoms such as abnormal heart rate and blood pressure and occasional syncope. A longtime Ultimate Frisbee player and coach, she began to feel so exhausted she could barely lift her arms.
“It felt like a concrete block was sitting on top of me,” she said. “I couldn't get out of bed. My husband had to wash and dry my hair and dress me.”
After the antiviral drug Tamiflu prescribed for her influenza infection relieved some of the symptoms of a long-standing COVID-19 infection, Leslie wondered if antiviral drugs related to COVID-19 would help her further. He said he wondered if that was the case. In February 2023, she found a doctor who prescribed Paxrobid for 15 days.
Afterwards, “I felt my body stabilize,” she said, adding, “I started to get my energy back.”
About six months later, she took another 15-day course, which she said helped her again. She estimates she can now operate at about 85% of her pre-COVID-19 level.
However, Leslie said some of her medical problems worsened after taking paxlobid, including an immune system condition that causes allergies. Three other patients also reported bothersome problems such as tingling and gastrointestinal discomfort after taking paxlobid.
Among those who felt no benefit from the drug was Julia Moore Vogel. Dr. Vogel, 39, a senior program director at Scripps Research, was a long-distance runner before contracting the coronavirus in July 2020, but now uses a wheelchair and is mostly homebound. She said there was.
She and her daughter recently moved across the country from California to live with her parents in Shagticoke, New York. “I got to the point where I either quit my job or I needed more help around the house,” she said. .
Dr. Vogel, whose symptoms included fatigue, post-exertion malaise, and migraines, took a 10-day course of Paxthrobid in April 2023. “It had no effect on me at all,” she said.
These days, I make ends meet by carefully calculating my energy budget and leaving the house only once a week. She said migraine medication provided some relief, but other than that, “I tried a lot of things and basically nothing helped me get better.”
Dr. Cohen said the report supports the theory that long-term COVID-19 infections have a variety of causes and treatments.
“The really important question is: Who can benefit from long-term administration of Paxlobid and why? And if it does help some symptoms, which ones? “Is it effective?” she said.
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