SARS-CoV-2 rebound with and without antivirals

[...]monoclonal antibodies have substantially reduced effectiveness against recently emerged strains,1 and should be tailored to the variants. [...]antiviral compounds, specifically nirmatrelvir–ritonavir, molnupiravir, and remdesivir, when used promptly at the onset of SARS-CoV-2 infection, are cur...

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Bibliographic Details
Published in:The Lancet infectious diseases 2023-06, Vol.23 (6), p.637-639
Main Author: Petrosillo, Nicola
Format: Article
Language:English
Subjects:
Antiviral agents
Antiviral Agents - pharmacology
Antiviral Agents - therapeutic use
Comment
Comorbidity
Coronaviruses
COVID-19
COVID-19 vaccines
Dermatologic Agents
Disease transmission
Drug dosages
Effectiveness
Humans
Infections
Infectious diseases
Monoclonal antibodies
Patients
Pharmacokinetics
Risk factors
Ritonavir
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
Steroids
Viral diseases
Virus Replication
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Summary:[...]monoclonal antibodies have substantially reduced effectiveness against recently emerged strains,1 and should be tailored to the variants. [...]antiviral compounds, specifically nirmatrelvir–ritonavir, molnupiravir, and remdesivir, when used promptly at the onset of SARS-CoV-2 infection, are currently the most effective drug therapies for inhibiting viral replication. In the outpatient setting, both nirmatrelvir–ritonavir and molnupiravir administered for 5 days have led to greater reductions in the relative risk of hospitalisation or death versus placebo in unvaccinated patients at high risk of severe COVID-19, with an associated decrease in nasopharingeal viral load.2,3 However, recently reported cases of virological rebound after completion of a 5-day course of nirmatrelvir–ritonavir have raised concerns around the real world effectiveness of antivirals againstSARS-CoV-2.4 In The Lancet Infectious Diseases, Wong and colleagues5 assessed the incidence of viral burden rebound, and evaluated associated risk factors and clinical outcomes, in a retrospective cohort of consecutive hospitalised patients with non-oxygen-dependent COVID-19 during the omicron BA.2.2 wave (from Feb 26 to July 3, 2022) in Hong Kong. Given that no association was found between oral antiviral treatment and viral burden rebound, the study by Wong and colleagues emphasises the importance of continuing to offer antivirals to individuals with COVID-19 who are at increased risk of progression to severe COID-19.
ISSN:1473-3099
1474-4457
DOI:10.1016/S1473-3099(23)00063-4