Some patients with long-term Covid treated with oral nirmatrelvir/ritonavir (Paxlovid) for an extended course report a reduction in their symptoms, in a small American case series. These results, admittedly mixed, presented by a team from the University of California San Francisco and published in Communications Medicine, nevertheless differ from those of a randomized trial published earlier in the year in the Jama Internal Medicineby a team from Stanford. This concluded, despite good safety, that there was no beneficial effect of Paxlovid on the symptoms of long Covid.
This new study has the particularity of having included patients particularly from the Patient-Led Research Collaborativea group of people with long Covid and associated chronic illnesses, and who are also researchers. So these are the patients in the series who reported on their symptoms and health experiences before, during and after prolonged treatment with Paxlovid.
Some responding patients
The case series included thirteen patients with long Covid, infected with different strains, all of whom started an extended course of Paxlovid for a duration of between 7.5 and 30 days (14 days on average). Among them, two suffered from acute reinfection with Sars-CoV-2 at the time of treatment.
Of those taking the treatment outside of an infectious context (there are eleven of them), seven report a significant reduction in their symptoms in the short term and four say they feel no effect on their symptoms. Additionally, one of these patients stopped treatment prematurely due to severe gastric pain.
-In total, only five of the thirteen patients saw lasting improvement. Overall, the improvement in symptoms mainly concerns muscular, neuropathic or cognitive manifestations, fatigue and cardiorespiratory function.
The results of this study nuance those of the Stanford team. As a reminder, this randomized controlled clinical trial (n = 155) showed that a 15-day course of Paxlovid (n = 102) did not alleviate the symptoms of long Covid. The authors noted, however, that additional research could show benefits for people with specific symptoms or at different doses. « If we have learned anything over the past four years, it is that long Covid is complex, and understanding why some people benefit from antiviral treatment while others do not is one of the most important questions in this area »considers a press release from the University of California.
