Researchers found that rebounded symptoms of COVID-19 after receiving treatment with Pfizer’s Paxlovid may be caused by a heightened immune response rather than a weak one, according to a report from Reuters. The report also noted that taking the drug over the recommended 5-day course was not found to reduce the risk of rebound symptoms. Patients who experienced rebound symptoms had higher levels of antibodies vs those who did not. This news comes as the CDC announced that starting October 20, it will cease daily reporting of COVID-19 cases in favor of weekly reports, hoping to reduce the reporting burden for state and local governments.
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cllady01
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I find this information pretty timely because I tested positive for Covid a couple of weeks ago, got the Paxlovid, tested negative after the five day course, then four days later have a case of rebound that is much worse than my original covid. I have to wonder if I’d have done better without the Paxlovid, though have no idea what my antibody levels were. My last booster was early January and I was getting ready for my next one.
My CLL specialist does not want his CLL patients to get Paxlovid. When I was doing a road trip late in the summer, I asked him what I should do if I got COVID and he told me to call him and he would prescribe Monoclonal Antibodies. I don’t know clearly what these are (other than what the name implies…) but I didn’t get COVID so did not have to find out. Someone else might be able to elaborate on the Monoclonal Antibodies.
Becky, the following from Yale Medicine lists what else is said to be available and the information is on CDC site also. I found this to be easy to read. it was Updated October 4, 2022.
Becky, the meds on the link from cllady01 are all approved, but the FDA has issued a caveat concerning Evusheld in view of new variants emerging fda.gov/drugs/drug-safety-a... Not all monoclonal antibodies for Covid are equal!
EDIT: I said "approved" but technically such meds are only "authorised" by the FDA for emergency use during the pandemic. They can easily be de-authorised, as was the case with monoclonal antibodies that ceased to be effective against Covid variants in circulation, e.g. Bamlanivimab, Ronapreve, Sotrovimab.
Does your specialist recommend against Paxlovid for all patients, or just those on BTKi therapy? Patients on BTKi's must stop their therapy while on Paxlovid due to metabolism changes that could cause more absorption of BTKi's, I believe.
I ended up with a staphylococcus infection 21 days after my frst COVID symptoms. I wish I had asked for the culture sooner. I ended up with otitis media in both ears that last several months, and is now realtively cleared. I do tend to get serious sinus infections.
I, too, got an antibiotic after the first week. The second week I saw the ENT, who gave a different antibiotic. The third week, I asked for a culture, and got a different antibiotic. On that day, I was still faintly rapid antigen positive, and PCR positive (no Ct value, though). Both ears were blocked the entire time.
Thanks for posting this. By coincidence I just stumbled across the same article.
In this study rebound was attributed to an excessive immune response. The observation that Patients who experienced rebound symptoms had higher levels of antibodies is not one I would associate with CLL patients, yet some of our members treated with Paxlovid have indeed reported rebound symptoms. So I think with immunocompromised Covid patients, something else is going on.
I found it strange also, I wonder how the excessive immune response was measured and to what it was attributed. Is the response to the Paxlovid? why does it occur at different times--some have the rebound happening after some 9 days and others seem to have it immediate after being tested as clear of COVID.
Could there be a T cell reaction of the immune system?
Rebound does seem to be a property of Paxlovid, though maybe it's just oft-reported because Remdesivir, which also acts by blocking viral replication within cells, is under-prescribed?
COVID-19 rebound after Paxlovid and Molnupiravir during January-June 2022
"Recent case reports document that some patients who were treated with Paxlovid experienced rebound COVID-19 infections and symptoms 2 to 8 days after completing a 5-day course of Paxlovid. "
...
"In summary, COVID-19 rebound (infection, symptoms, and hospitalizations) occurred for both drug treatments. The risks for rebound did not differ between Paxlovid and Molnupiravir, indicating that COVID-19 rebound is not unique to Paxlovid. The rebound rates increased as the time elapsed after treatment, suggesting inadequate viral clearance by the treatments."
I don't know of any paper, including this most recent one, that concludes that the drug is the cause of the rebound. The cause is clearly the virus itself. Immune function varies between patients - as we with CLL know so well. So the most recent paper tried to document immune responses - cell types, antibody counts, T-cell responses, and cytokines - to see how patients differ.
Although this is a small (interim) study, it does dispel the notion that Covid treatment rebound is necessarily due to a dysfunctional immune system. In the UK, though, it could well be, because Paxlovid treatment is available only to immunosuppressed Covid patients and only if commenced within 5 days of onset of symptoms.
It adds to this study nature.com/articles/d41586-... which shows that what people describe as Covid rebound can be different things, and doesn't have to involve treatment.
> In this study rebound was attributed to an excessive immune response.
I don't think that's what they were saying.
> The observation that Patients who experienced rebound symptoms had higher levels of antibodies is not one I would associate with CLL patients, yet some of our members treated with Paxlovid have indeed reported rebound symptoms.
I agree! I am one of the CLL patients with documented low total IgA, IgG, and IgM, who experienced a rebound based on rapid antigen test evidence during immediately after final dose, and several days after final dose Paxlovid, despite Evusheld.
The paper argues that the reason for the rebound is still probably duration of treatment. From the paper, not the AJMC article:
"The presence of infectious virus supports the need for isolation and assessment of longer treatment courses."
The study did not attempt to match rebound patients with level of virus before vs after Paxlovid. They only looked at 15 patients total - 8 rebound, 7 non-rebound.
I think there was a ton of data on very few patients, and very little conclusion can be drawn regarding whether to use Paxlovid or not. They provide detailed serology data on what's going on during infections in a fairly motley group of unmatched patients, I think.
I imagine they would be appalled at conclusions drawn against the use of Paxlovid.
> Researchers found that rebounded symptoms of COVID-19 after receiving treatment with Pfizer’s Paxlovid may be caused by a heightened immune response rather than a weak one, according to a report from Reuters.
What is the reader supposed to take from that sentence? Paxlovid is Good, or Paxlovid is Bad?
Clinical, Virologic, and Immunologic Evaluation of Symptomatic Coronavirus Disease 2019 Rebound Following Nirmatrelvir/Ritonavir Treatment
Their conclusions in the abstract were:
"Nirmatrelvir/ritonavir treatment does not impede adaptive immune responses to SARS-CoV-2. Clinical rebound corresponds to development of a robust antibody and T-cell immune response, arguing against a high risk of disease progression. The presence of infectious virus supports the need for isolation and assessment of longer treatment courses."
Conclusions in the full text:
"In conclusion, this case series provides important insights into the pathophysiology of rebound COVID-19 after NMV-r. None of our patients developed severe disease at rebound, and adaptive immunity against SARS-CoV-2 appeared intact. Our findings suggest that a more robust immune response rather than uncontrolled viral replication characterizes these clinical rebounds.Special consideration should be given for immunocompromised patients who cannot rely on adaptive immune responses and therefore may require prolonged or additional therapies. Further detailed evaluation in larger cohorts is required to assess the incidence, clinical, and, importantly, epidemiologic implications of rebound COVID-19."
I think this was a vastly underpowered study, because they only looked at 15 patients altogether - 8 in the rebound group and 7 without.
They were not matched in any way that I can tell - see Table 2. This is not a comparative study as much as it's a review of 15 separate cases to check some prevailing theories about rebound, to see what a subsequent study should look for, and to document methodology.
Thank you, Seymour--I suspect there will be more info coming---it is difficult to take in that which is not finished in the studies, but maybe we can build on these to provide as quickly as we can, the full story.
It is good to know there is work being done by those who have access to the means to find the answers. We can be thankful for those who are laboring to decipher the outcomes.
I fear that those most at risk - especially in our patient population - will fear treatment, and suffer dire fates.
There are signs that some immune compromised patients experience longer infections than immuno-normies. Some chronic COVID infections have been documented to several months.
In light of the increase in variants that escape previous infectuons, Evusheld and bebtelovimab, antivirals are the only weapon we have.
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anyone not take Paxlovid?
Message: please stay home 
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