I read the original “Covid rebound” results. They said that the five per cent rebound with Paxlovid was identical in the control group. Paxlovid does not cause the rebound; it simply does not prevent it. I’ve never read a single article that refers to this. It seems that a Paxlovid rebound is an attractive story. Am I wrong?
I read the original “Covid rebound” results. They said that the five per cent rebound with Paxlovid was identical in the control group. Paxlovid does not cause the rebound; it simply does not prevent it. I’ve never read a single article that refers to this. It seems that a Paxlovid rebound is an attractive story. Am I wrong?
It's an important question. I'm only aware of 3 sources on this; the Pfizer trial (claiming 2% rebound in Paxlovid and placebo), and 2 poor studies from Mayo (<1%) and Case Western (5%), neither of which compared to a control group not given Paxlovid (ie they did not answer your question). The problem w/ the Pfizer data is a) it's from Pfizer media reports and they never showed us the data and b) it does not match the bit of data they shared w/ the FDA which suggests >10% rate. The other 2 studies were retrospective and pulled from EHR records, which is an inherently terrible approach to getting an accurate answer (how often does a patient's rebound actually merit a correct ICD-10 code from their MD in an EHR?). I honestly believe any physician who actually prescribes Paxlovid will tell you the rate is over 10%. Now, to your question, how often does "viral rebound" happen on its own? A lot less, anecdotally. The pre-Omicron (like the Pfizer trials) data from the NBA bubble suggests positive-negative-positive testing virtually never happened. I haven't seen published data on Omicron, but have seen a couple anecdotes (out of 100s of cases!) where a patient seems to have cleared their covid symptoms and then they roar back after 1-2 days. I don't know that they would have tested negative dueing the symptom lull, which is a feature of Paxlovid rebound which makes it so insidious. I do think we'll have an answer fairly soon; an interesting teaming of Eric Topol and Michael Mina is apparently running a study on this. The concept is incredibly simple and easy as studies go: get a few hundred patients, randomize (or case match if you are not up for randomization) to Paxlovid or control, give them each a bunch of rapid tests, and get a daily test/symptom report for 2 weeks. It's frankly embarrassing that a major institution like Mayo published a retrospective, EHR-based study claiming an absurdly low number instead of doing this. The seduction of quick, cheap results from chart reviews...
I read the original “Covid rebound” results. They said that the five per cent rebound with Paxlovid was identical in the control group. Paxlovid does not cause the rebound; it simply does not prevent it. I’ve never read a single article that refers to this. It seems that a Paxlovid rebound is an attractive story. Am I wrong?
It's an important question. I'm only aware of 3 sources on this; the Pfizer trial (claiming 2% rebound in Paxlovid and placebo), and 2 poor studies from Mayo (<1%) and Case Western (5%), neither of which compared to a control group not given Paxlovid (ie they did not answer your question). The problem w/ the Pfizer data is a) it's from Pfizer media reports and they never showed us the data and b) it does not match the bit of data they shared w/ the FDA which suggests >10% rate. The other 2 studies were retrospective and pulled from EHR records, which is an inherently terrible approach to getting an accurate answer (how often does a patient's rebound actually merit a correct ICD-10 code from their MD in an EHR?). I honestly believe any physician who actually prescribes Paxlovid will tell you the rate is over 10%. Now, to your question, how often does "viral rebound" happen on its own? A lot less, anecdotally. The pre-Omicron (like the Pfizer trials) data from the NBA bubble suggests positive-negative-positive testing virtually never happened. I haven't seen published data on Omicron, but have seen a couple anecdotes (out of 100s of cases!) where a patient seems to have cleared their covid symptoms and then they roar back after 1-2 days. I don't know that they would have tested negative dueing the symptom lull, which is a feature of Paxlovid rebound which makes it so insidious. I do think we'll have an answer fairly soon; an interesting teaming of Eric Topol and Michael Mina is apparently running a study on this. The concept is incredibly simple and easy as studies go: get a few hundred patients, randomize (or case match if you are not up for randomization) to Paxlovid or control, give them each a bunch of rapid tests, and get a daily test/symptom report for 2 weeks. It's frankly embarrassing that a major institution like Mayo published a retrospective, EHR-based study claiming an absurdly low number instead of doing this. The seduction of quick, cheap results from chart reviews...