Scientists report that Paxlovid alleviated long-term symptoms of Covid-19 in some patients

Can Paxlovid treat long-term Covid? AND new report suggests it could support some patients, but it is unclear which patients might benefit from it.

The report, published Monday in the journal Communications Medicine, describes the cases of 13 long-Covid patients who underwent extended courses of the antiviral drug. The results were decidedly mixed: nine patients reported some improvement, but only five said it was lasting. Four people reported no improvement.

Perhaps most importantly, the report highlights that almost five years after the pandemic began, little is still known about what might support the millions of people infirmed with Covid-19. Although some people improve on their own or with various therapies and medications, no treatment has yet proven universally effective.

“People with long-term Covid are eager to take advantage of therapies that can support,” said Alison Cohen, an epidemiologist at the University of California, San Francisco, author of the up-to-date report and a long-time Covid sufferer herself. “A lot of research has been done, but progress is still snail-paced.”

Paxlovid, made by Pfizer, is considered an enticing prospect because it can prevent solemn illness during lively Covid infections, and also because patients who take the five-day course while infected are less likely to later develop Covid-19.

Also, a theory that may be due to some long Covid cases virus residues in the body suggests that an antiviral drug such as Paxlovid may alleviate these symptoms by killing off any lingering virus.

Last year, the first randomized trial of Paxlovid for long Covid it brought no benefits. It was conducted at Stanford and involved 155 patients who took either the drug or a placebo for 15 days. Although it was deemed sheltered to take Paxlovid for this long time, it didn’t support patients much: ten weeks later, the placebo and Paxlovid groups showed no significant difference in the severity of long-term Covid symptoms.

Dr. Upinder Singh, an infectious disease specialist and leader of this study, said his results and the up-to-date report primarily generated “more questions that need to be answered”: Can Paxlovid support if taken for longer than 15 days or in combination with other medicines? Does its effect vary depending on the type of symptoms or when they appear?

“It’s very possible that there are different types of disease occurring over the course of long Covid,” said Dr. Singh, now chief of internal medicine at the University of Iowa. Perhaps Paxlovid or other antiviral drugs would support patients in whom it could be clearly determined that the virus persists in the body, she added.

Akiko Iwasaki, an immunologist at Yale University, said scientists should not “throw in the towel” on the possibility of using antiviral drugs long term for Covid.

“If you look collectively, there’s no difference between the placebo group, but the case reports show that there are people who really benefit, so we need to focus on those people,” said Dr. Iwasaki, who is leading another randomized trial of Paxlovid, which the results have not yet been published.

She said crucial next steps would be to identify biological markers in people whose long-term Covid-19 symptoms improved with Paxlovid and to see if other antiviral drugs support other patients.

The up-to-date report was not a clinical trial, but a collection of self-reports from 13 long-term Covid patients from across the country who tried extended courses of Paxlovid. This is the first published case series of such patients, according to the authors, who include Dr. Michael Peluso, an infectious diseases physician at UCLA, and members of the Patient-Led Research Collaborative, a group of researchers who also have long-term Covid cases.

The authors say the patients’ experiences were too diverse to provide a consistent trajectory, but the diversity could provide clues for larger studies.

The patients, aged 25 to 55, were infected between March 2020 and December 2022. They experienced at least one of a range of symptoms, including fatigue; gastrointestinal problems; cognitive problems such as brain fog; muscle pain; irregular heart rate; and a condition called post-exertional malaise, in which physical or mental exertion causes failure.

Like the Stanford study, most patients in the up-to-date report were vaccinated before receiving Paxlovid. Their Paxlovid courses lasted from 7.5 to 30 days. Most have tried it to find relief from long-standing Covid-19 symptoms; two long Covid patients received extended courses of Paxlovid after being reinfected with the virus.

Most patients were also taking other medications or supplements, making it tough to determine the specific effect of the drug, Dr. Cohen said. Still, some people claimed that Paxlovid helped them significantly.

Kate Leslie, 46, a social worker in Boulder, Colorado, said she was well and fit before contracting the coronavirus in March 2022. Six weeks later, she said, she felt like she had a concussion, struggling to think clearly or find words.

She developed postural orthostatic tachycardia syndrome with symptoms including irregular heart rate and blood pressure and occasional syncope. As a longtime Ultimate Frisbee player and coach, she began to feel profoundly tired and could barely lift her arms.

“It was like there were concrete blocks on top of your body,” she said. “I couldn’t get out of bed. My husband had to wash, parched and dress me.”

After she was prescribed an antiviral drug for a flu infection, Tamiflu, which eventually alleviated some of her long-term Covid symptoms, Ms Leslie wondered whether antiviral drugs for Covid might support even more, she said. In February 2023, she found a doctor who prescribed a 15-day course of Paxlovid.

Then “I felt my body stabilize,” she said, adding: “I started getting my energy back.”

About six months later, she received another 15-day course, which helped again, she said. He estimates he can now function at about 85 percent of his pre-Covid level.

However, Ms Leslie said several of her health problems had worsened after taking Paxlovid, including an immune system disease that causes allergies. Three other patients also reported troublesome problems after taking Paxlovid, including tingling and gastrointestinal discomfort.

Among those who saw no benefit from the drug was Julia Moore Vogel. Dr. Vogel (39), a senior program director at Scripps Research, was a long-distance runner before she was infected with the coronavirus in July 2020. Currently, he uses a wheelchair and largely does not leave the house, she said.

She and her daughter recently moved from California to live with her parents in Schaghticoke, Novel York. “It got to the point where we decided I either had to stop working or we needed more support around the house,” she said. .

Dr. Vogel, whose symptoms include fatigue, post-exertional malaise and migraines, took a 10-day course of Paxlovid in April 2023. “It just didn’t affect me at all,” she said.

These days, she copes by carefully planning her energy, trying to leave the house no more than once a week. She said migraine medication provided some relief, but other than that, “I tried a lot of things and basically nothing helped me get any better.”

Dr Cohen said the report reinforces the theory that long Covid has many different causes and treatments.

“The really crucial question is who might benefit from extended treatment with Paxlovid and why,” she said, “and if it benefits some symptoms, what symptoms?”