The risk of a Paxlovid rebound: 3 notes

For months, the risk of taking Paxlovid then having rebounding symptoms or a second positive test happening days after a negative result has been a source of debate, but some say the benefits eclipse the minor risk. 

After the FDA approved Paxlovid in late 2021, Pfizer's COVID-19 antiviral drug quickly rose in popularity to treat post-infection symptoms. Paxlovid has a rebound risk of about 2 percent, but after notable figures such as President Joe Biden, National Institute of Allergy and Infectious Diseases Director Anthony Fauci, MD, and first lady Jill Biden, EdD, reported COVID-19 rebound cases after taking the treatment, some have wondered if the risk figure needs updated.

Physicians recently told ABC News Paxlovid rebounds happen between 10 percent to 30 percent of cases, but the real risk is unclear. 

Here are three recent notes: 

1. A research letter published Oct. 27 in JAMA found that among 158 study participants, rebounds occurred among people who took Paxlovid and those who took a placebo. 

2. Taking the antiviral past the recommended five-day regimen did not reduce the risk of a rebound, a small Oct. 6 study from the National Institutes of Health found. The same study found that rebounding COVID-19 symptoms are not linked to an impaired immune response.

3. FDA Commissioner Robert Califf, MD, recently responded to the discussion about Paxlovid, reaffirming that the benefits outweigh potential risks. 

"I'm concerned that the discussions about 'Paxlovid rebound' are distracting us from the basis for the emergency use authorization, or EUA: a substantial reduction in death and hospitalization for high-risk patients," Dr. Califf wrote in a Nov. 1 Twitter thread. "Rebound or not, Paxloxid was authorized on the basis of a nearly 90 percent reduction in the risk of hospitalization or death in a clinical trial, in patients at high risk for progression to severe COVID-19; and not on the basis of change in duration of symptoms or viral load reduction."


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