Thank you again for your weekly insights and guidance.
I feel like mAbs used to be right up there with Paxlovid, on the list for Rx of mild-mod early ds, and Remdesivir was 3rd and molnupiravir last. But perhaps that was when Sotrovimab was still relevant? Now mAbs have fallen to the “C” or weak recommendation. I realize there is only “in vitro” data indicating effectiveness against the BA.2 variant, and no phase 3 clinical trials. But many of my colleagues are still scheduling patients for Bebtelovimab infusions, as long as we have it in stock – even in patients who could perhaps take Paxlovid. And giving Remdesivir IV x3 days is simply a pain in the arse. Should they not be? We even give Bebtelovimab right in the ED, when time permits. It’s like a “one-and-done”…. for those mild-mod Pts w/ risk factors for progression, yet in the first 5-7 days.
I apologize in advance if I’ve misinterpreted the guidelines – or missed one of your clinical updates! (possible)
Hi there our local pharmacist doesn’t know how recently kidney function needs to be checked before prescribing paxlovid. Any ideas? Within 30 days? 90 days? If no history of kidney disease. Thanks!
Tara Frazier-Rice FNP
Hello Vincent and Daniel,
I just read this update from Dr Farley and see that the trial data did see 1-2% of the “rebound”.
In light of these reports, additional analyses of the Paxlovid clinical trial data have been performed. In the Paxlovid clinical trial, some patients (range 1-2%) had one or more positive SARS-CoV-2 PCR tests after testing negative, or an increase in the amount of SARS-CoV-2 detected by PCR, after completing their treatment course. This finding was observed in patients treated with the drug as well as patients who received placebo, so it is unclear at this point that this is related to drug treatment. Additional analyses show that most of the patients did not have symptoms at the time of a positive PCR test after testing negative, and, most importantly, there was no increased occurrence of hospitalization or death or development of drug resistance.
We are continuing to review data from clinical trials and will provide additional information as it becomes available. However, there is no evidence of benefit at this time for a longer course of treatment (e.g., 10 days rather than the 5 days recommended in the Provider Fact Sheet for Paxlovid) or repeating a treatment course of Paxlovid in patients with recurrent COVID-19 symptoms following completion of a treatment course.”
These reports, then, do not change the conclusions from the Paxlovid clinical trial which demonstrated a marked reduction in hospitalization and death.
I have to wonder if immunocompromised Px (part of the high risk group) are unable to fully clear the virus due to their impaired immunity? This is just speculation of course.
A question I haven’t heard you address yet: if one is in a university or company that does regular surveillance testing and one tests positive but has no symptoms, should one try to get Paxlovid? I help run the surveillance testing lab at Caltech, and was wondering about your opinion. We have a lot of faculty and staff who are >60 that are getting tested. Would your advice to them depend on age and comorbidities? If so, what would be the cutoff age at which one should try to get Paxlovid as soon as one tests positive, without waiting to develop symptoms?
Howard and Gwen Laurie Smits Professor of Biology and Biological Engineering
California Institute of Technology