Paxlovid, a COVID-19 antiviral medication developed by Pfizer, has been the subject of recent research on its potential use to treat Long COVID. Paxlovid is a combination of two drugs – nirmatrelvir and ritonavir – that work together to inhibit the SARS-CoV-2 virus and reduce the risk of severe illness from COVID-19, National Institute of Health.
While Paxlovid has been shown to be highly effective in reducing hospitalizations and deaths for those newly infected with COVID-19, recent studies have examined its impact on the long-term symptoms associated with Long COVID.
Researchers from Stanford University conducted a 15-week, 155-participant study to evaluate whether a 15-day course of Paxlovid could alleviate the persistent fatigue, brain fog, shortness of breath, and other debilitating symptoms experienced by those with Long COVID . However, the study found that the Paxlovid treatment did not provide any significant benefit over a placebo in reducing these long-term COVID-19 symptoms.
Notwithstanding the negative findings, the researchers noted that further investigation into using Paxlovid for Long COVID may still be warranted, as the optimal treatment duration or timing of administration for this condition remains unclear . The study did confirm that extended Paxlovid use over 15 days was safe, which could inform future research directions
In another study, Lavanya Visvabharathy, a research professor of neurology at the Northwestern University Feinberg School of Medicine who has studied Long COVID since 2020, decided to conduct an experiment on herself after continuing to test positive on antigen tests and experience symptoms like headaches and intense fatigue months after catching COVID-19 in December 2021. Believing that remnants of the virus were still present in her system, Visvabharathy hypothesized that Paxlovid, an antiviral therapy known for inhibiting the replication of the virus, could potentially alleviate her Long COVID symptoms. She published the results of her experiment as a case report in Frontiers in Medicine in September 2022.
After a course of Paxlovid, Visvabharathy’s symptoms initially improved and she tested negative, but the symptoms later resurfaced. She temporarily halted her immunosuppressant medication for rheumatoid arthritis, which led to exacerbated symptoms including severe brain fog, but the brain fog resolved upon resuming her arthritis treatment.
While Visvabharathy eventually recovered after enduring Long COVID symptoms for about nine months, the role of Paxlovid in her recovery remains uncertain. Studies indicate that early Paxlovid administration post-infection may reduce the likelihood of developing Long COVID, but the effectiveness of Paxlovid in reversing existing symptoms requires further investigation.
According to a case report published in the Journal Pathogens and Immunity in June, three patients reported improvements in their post-COVID symptoms after taking Paxlovid, with one patient seeing “substantial improvement” after taking the drug for more than two years.
Dr. Upinder Singh, a professor of infectious disease at Stanford Medicine, describes the findings as “titillating,” but says more research is needed to draw firm conclusions about Paxlovid’s role in treating Long COVID. 200 patients with moderate to severe Long COVID-19 symptoms are being recruited by Singh’s research team. Of these, 200 will be treated with Paxlovid for 15 days, the maximum amount of time the medication has been shown to be safe. Another 200 participants will receive a placebo.
The two groups will then be monitored for four months to assess changes in their symptoms. While this study has already begun enrolling patients, the results have yet to be released.
Larger clinical trials, such as the one led by Dr. Singh, are required to better understand Paxlovid’s efficacy in treating Long COVID. The promising case report findings warrant further investigation, but no definitive conclusions about the drug’s efficacy can be drawn until more comprehensive studies are completed.
Conclusion
Paxlovid, which is currently approved for the treatment of acute COVID-19 in high-risk individuals, has shown promising results in reducing hospitalizations and deaths. However, its efficacy in addressing the long-term effects of COVID-19 remains uncertain. Researchers are continuing to explore Paxlovid and other potential treatments for Long COVID. As the scientific community works to unravel the complexities of this condition, patients and healthcare providers await the development of effective therapies to alleviate the debilitating symptoms of Long COVID.
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References
Centers for Disease Control and Prevention. (2023). Post-COVID Conditions. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html
Arbel, R., Wolff Sagy, Y., Hoshen, M., Balicer, R. D., Dagan, N., & Weiss, P. (2022). Nirmatrelvir and the Risk of Post-Acute Sequelae of COVID-19. medRxiv. https://doi.org/10.1101/2022.11.03.22281783
ClinicalTrials.gov. (n.d.). Study to Evaluate the Efficacy and Safety of Paxlovid for the Treatment of Long COVID (PAXLOVID-LC). https://clinicaltrials.gov/ct2/show/NCT05595369
University of California San Francisco. (2024, January). Study Finds Paxlovid Treatment Does Not Reduce Risk of Long COVID. https://www.ucsf.edu/news/2024/01/426906/study-finds-paxlovid-treatment-does-not-reduce-risk-long-covid
