The use of Pfizer Inc.’s PFE.N antiviral COVID-19, Paxlovid, increased this week, but some doctors are reconsidering the pills for lower-risk patients after a U.S. public health agency warned that symptoms may recur after people have completed a course of the drug, and then they should be isolated a second time.
More people in quarantine “don’t like the crowd,” Dr. Sandra Kemmerly, an infectious disease specialist at Ochsner Health in New Orleans, told Reuters. “For those people who aren’t really at risk … I’d recommend that they don’t take it.”
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Pfizer’s use of Paxlovid, authorized to treat newly infected people at risk for serious illness, has skyrocketed as infections have increased. More than 162,000 courses were dispensed last week, compared to an average of 33,000 a week since the drug was launched late last year, according to government data. Biden administration officials have pushed for widespread use of Paxlovid, which the government bought and provided for free.
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But higher use has also come with more reports of people saying their symptoms were relieved with Paxlovid only to return a few days after ending a five-day regimen of the pills.
On Tuesday, the Centers for Disease Control and Prevention, citing case reports and concerns that relapsed patients could spread the virus, issued a warning that Paxlovid users should be isolated for five days depending on whether symptoms recover.
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“I’m avoiding giving it to people who are at very low risk and who aren’t very sick, especially people who are vaccinated and strengthened,” said Dr. Bruce Farber, head of public health and epidemiology at Northwell Health. He said he still recommends Paxlovid for people who have serious health problems or are over 75 years old.
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Pfizer, in an email, said it is monitoring the data, but believes the return of the detectable virus is uncommon and is not exclusively associated with its drug. “So far we have not seen any resistance in patients treated with Paxlovid,” a spokesman said.
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The Paxlovid emergency permit stipulates that it should only be used for people newly infected with risk factors, but doctors said many others have requested a prescription.
“We get a lot of applications, maybe someone is traveling and they want to accept it just in case,” said Dr. Tara Vijayan, an infectious disease specialist at UCLA Health in Los Angeles. “We don’t offer it just in case.”
The CDC also said it is unclear whether cases of rebound symptoms have anything to do with Paxlovid or are simply part of COVID-19’s natural trajectory. The agency did not show any specific concerns about the health effects.
“COVID has historically had this kind of stuttering course: people will feel better one day and then feel worse the next day, but I can say we haven’t seen these rebound symptoms with other COVID treatments,” Vijayan said. referring to therapies such as monoclonal antibodies.
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“Patients who get a bounce are usually very mild,” said Dr. Earl Strum, medical director of health for employees at Keck Medicine at USC in Los Angeles.
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Some wonder how much Paxlovid is helping given the high number of people who have been vaccinated or previously infected with COVID-19. The drug was released in December after a study in unvaccinated and high-risk COVID patients with conditions such as diabetes showed an 88% reduction in hospitalization or death.
At the time, the Delta variant was prevalent, but has since been replaced by the more transmissible Omicron.
“There’s a lot more reference immunity around. There are still a lot of infections, but they’re not that serious,” Farber of Northwell said.
Read more: Oral treatment with Paxlovid does not prevent COVID-19 in household members: Pfizer
He estimated the rate of Paxlovid-related COVID bounces at around 10%, higher than the 3-4% rate cited by Pfizer in his drug trials.
Jason Gallagher, an infectious disease expert at Temple University School of Pharmacy, said the bounce does not harm the drug’s usefulness. “It keeps you from going to the hospital … if you become symptomatic after you stop taking it, it stinks, but the medicine was generally a success,” he said.
– Report by Deena Beasley in Los Angeles