A recent case series indicates that extended courses of Paxlovid (nirmatrelvir/ritonavir) may alleviate symptoms for some individuals suffering from long COVID. The study, published in Communications Medicine, tracked 13 patients with long COVID who underwent extended Paxlovid treatment, with some experiencing notable improvements.
The research emerges amidst ongoing efforts to identify effective treatments for long COVID, a condition affecting millions globally. The CDC estimates that 1 in 13 adults in the US have long COVID, characterized by persistent symptoms such as fatigue, brain fog, and respiratory issues.
Study Details and Findings
The study, conducted by researchers at the University of California-San Francisco (UCSF), involved a detailed analysis of patients who received Paxlovid for longer than the standard five-day course. Participants were identified through long COVID support groups and patient referrals.
Alison Cohen, PhD, MPH, assistant professor of epidemiology and biostatistics at UCSF and lead researcher of the study, noted the lack of approved treatments for long COVID, stating, "We are about five years into the pandemic, and yet there are not yet any federally-approved treatments for long COVID. This is not a silver bullet, but it may help a lot of people in a meaningful way."
Of the 13 patients, five experienced sustained improvements in their long COVID symptoms. These patients had varying treatment lengths, with many receiving Paxlovid for 15 days. For instance, a 56-year-old man with two years of fatigue, headaches, and brain fog reported significant relief after a 15-day course. However, a 45-year-old woman experienced only a temporary reprieve from a five-day course, with no benefit from a subsequent 15-day course.
Contrasting Evidence and Future Directions
These findings contrast with a randomized controlled trial published in JAMA Internal Medicine in June 2024, which found that a 15-day Paxlovid course was safe but did not significantly reduce long COVID symptoms. The UCSF researchers suggest that different dosages, patient selection, or treatment timing might explain the discrepancies.
Michael Peluso, MD, an infectious disease researcher at UCSF, emphasized the complexity of long COVID, stating, "If we’ve learned one thing over the last four years, it’s that long COVID is complex, and figuring out why some people benefit so remarkably from antiviral treatment while others don’t is one of the most important questions for the field. We are going to need to embrace that complexity to get answers for the millions of people suffering from this condition."
The researchers advocate for further studies to identify which patients are most likely to benefit from Paxlovid and to determine the optimal treatment duration. They also suggest exploring other antiviral treatments for long COVID.
Implications for Clinical Practice
While the case series provides encouraging evidence, clinicians are advised to exercise caution and consider individual patient factors when prescribing Paxlovid for long COVID. The heterogeneity of long COVID symptoms and the mixed results observed in the study underscore the need for personalized treatment approaches.
The study highlights the urgent need for more research into effective treatments for long COVID, a condition that continues to pose significant challenges to healthcare systems worldwide.
