ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2024
Symptoms, Viral Loads, and Rebound Among COVID-19 Outpatients Treated With Nirmatrelvir/Ritonavir Compared With Propensity Score-Matched Untreated Individuals.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.
What it found
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The trial behind it
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Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it, 33 citations in OpenAlex.
- SARS-CoV-2 infection rebound among patients receiving antiviral agents, convalescent plasma, or no treatment: a systematic review with meta-analysis.Blood transfusion = Trasfusione del sangue · 2024Pooled it
- Viral and Symptom Rebound Following Anti-Severe Acute Respiratory Syndrome Coronavirus 2 Monoclonal Antibody Therapy in a Randomized Placebo-Controlled Trial.The Journal of infectious diseases · 2025Trial
- COVID-19 Rebound After VV116 vs Nirmatrelvir-Ritonavir Treatment: A Randomized Clinical Trial.JAMA network open · 2024Trial
- Development and Validation of an Electronic Health Record-Derived Prediction Model for Preventing COVID-19 Hospitalization and Death.Prevention science : the official journal of the Society for Prevention Research · 2026Article
- Influenza mitigation recommendations, symptoms, and viral RNA shedding durations-2023-24 and 2024-25 seasons.American journal of epidemiology · 2026Article
- COVID-19 Rebound in Nirmatrelvir Plus Ritonavir Treatment and Control Groups: Prospective Cohort Study.Interactive journal of medical research · 2026Article
- Estimating the generation time for SARS-CoV-2 transmission using United States household data, December 2021-May 2023.Scientific reports · 2026Article
- Immune-endothelial-coagulation crosstalk as a driver of multi-organ dysfunction in severe viral pneumonia.Frontiers in immunology · 2026Review
- Social vulnerability and the risk of respiratory virus infection in households: a case-ascertained study.BMC infectious diseases · 2025Article
- Disparate SARS-CoV-2 Infection Outcomes Abound, but What Makes SARS-CoV-2 Bound for Rebound?The Journal of infectious diseases · 2025Article
- SARS-CoV-2 rebound and post-acute mortality and hospitalization among patients admitted with COVID-19: cohort study.Nature communications · 2025Article
- Kinetics of SARS-CoV-2 Shedding in Nursing Home Residents and Staff.Journal of the American Geriatrics Society · 2025Article
- Incidence of COVID-19 Symptom Rebound After Treatment with Remdesivir.Infectious disease reports · 2025Article
- Modeling suggests SARS-CoV-2 rebound after nirmatrelvir-ritonavir treatment is driven by target cell preservation coupled with incomplete viral clearance.Journal of virology · 2025Article
- Persistence of an Infectious Form of SARS-CoV-2 After Protease Inhibitor Treatment of Permissive Cells In Vitro.The Journal of infectious diseases · 2025Article
- Factors Influencing COVID-19 Viral Clearance: Implications for Vaccination and Antiviral Therapy.Infection and drug resistance · 2025Article
- Replication capacity and susceptibility of nirmatrelvir-resistant mutants to next-generation Mpro inhibitors in a SARS-CoV-2 replicon system.Antiviral research · 2024Article
- Modeling suggests SARS-CoV-2 rebound after nirmatrelvir-ritonavir treatment is driven by target cell preservation coupled with incomplete viral clearance.bioRxiv : the preprint server for biology · 2024Article
- Clinical rebound after treatment with nirmatrelvir/ritonavir in COVID-19.BMC infectious diseases · 2024Article
- Emerging SARS-CoV-2 Resistance After Antiviral Treatment.JAMA network open · 2024Article
Corrections and comments
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Authors and funding
37 authors at 10 institutions in 1 country.
Funding
Abstract
backgroundNirmatrelvir/ritonavir (N/R) reduces severe outcomes from coronavirus disease 2019 (COVID-19); however, rebound after treatment has been reported. We compared symptom and viral dynamics in individuals with COVID-19 who completed N/R treatment and similar untreated individuals.
methodsWe identified symptomatic participants who tested severe acute respiratory syndrome coronavirus 2-positive and were N/R eligible from a COVID-19 household transmission study. Index cases from ambulatory settings and their households contacts were enrolled. We collected daily symptoms, medication use, and respiratory specimens for quantitative polymerase chain reaction for 10 days during March 2022-May 2023. Participants who completed N/R treatment (treated) were propensity score matched to untreated participants. We compared symptom rebound, viral load (VL) rebound, average daily symptoms, and average daily VL by treatment status measured after N/R treatment completion or 7 days after symptom onset if untreated.
resultsTreated (n = 130) and untreated participants (n = 241) had similar baseline characteristics. After treatment completion, treated participants had greater occurrence of symptom rebound (32% vs 20%; P = .009) and VL rebound (27% vs 7%; P < .001). Average daily symptoms were lower among treated participants without symptom rebound (1.0 vs 1.6; P < .01) but not statistically lower with symptom rebound (3.0 vs 3.4; P = .5). Treated participants had lower average daily VLs without VL rebound (0.9 vs 2.6; P < .01) but not statistically lower with VL rebound (4.8 vs 5.1; P = .7).
conclusionsIndividuals who completed N/R treatment experienced fewer symptoms and lower VL but rebound occured more often compared with untreated individuals. Providers should prescribe N/R, when indicated, and communicate rebound risk to patients.
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Registered trials
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