Incidence of COVID-19 Symptom Rebound After Treatment with Remdesivir

DOI record: { "DOI": "10.3390/idr17030043", "ISSN": [ "2036-7449" ], "URL": "http://dx.doi.org/10.3390/idr17030043", "abstract": "<jats:p>Background/Objectives: Recent in vitro data suggest that remdesivir might be less likely than nirmatrelvir–ritonavir to be associated with COVID-19 rebound. We compared the incidence of symptom rebound in our remdesivir-treated cohort with rates reported in the literature for nirmatrelvir–ritonavir. Methods: We performed a retrospective cohort study of VA Boston Healthcare System patients who were nursing home residents or inpatients treated with remdesivir for mild to moderate COVID-19 that met clinical criteria for nirmatrelvir–ritonavir treatment between 05/2022 and 10/2024. Electronic health records were reviewed for evidence of symptom rebound in daily clinical evaluations and outside hospital care notes for 15–20 days after the diagnosis of COVID-19. Rates for nirmatrelvir–ritonavir were identified via a literature review. Results: Among 194 patients treated with remdesivir, 39 were excluded due to concurrent antiviral use, hypoxia, or ICU-level care. The average age of the remaining 155 patients was 75.1 ± 11.9 years; 147 patients (95%) were male. Evidence of symptom rebound was found in 1 of 155 (0.6%) remdesivir-treated patients, which is a rate lower than that reported in all 12 studies of nirmatrelvir–ritonavir symptom rebound during the Omicron era. Conclusions: Our finding of low rates of COVID-19 symptom rebound after treatment with remdesivir are consistent with the hypothesis that rebound may be less frequent after treatment with remdesivir than with nirmatrelvir–ritonavir.</jats:p>", "alternative-id": [ "idr17030043" ], "author": [ { "affiliation": [ { "name": "VA Boston Healthcare System, West Roxbury, MA 02132, USA" }, { "name": "Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02111, USA" } ], "family": "Gupta", "given": "Kalpana", "sequence": "first" }, { "affiliation": [ { "name": "VA Boston Healthcare System, West Roxbury, MA 02132, USA" }, { "name": "Veterans Affairs Informatics and Computing Infrastructure, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT 84148, USA" } ], "family": "O’Brien", "given": "William J.", "sequence": "additional" }, { "affiliation": [ { "name": "VA Boston Healthcare System, West Roxbury, MA 02132, USA" }, { "name": "Department of Medicine, Harvard Medical School, Boston, MA 02115, USA" } ], "family": "Strymish", "given": "Judith", "sequence": "additional" }, { "affiliation": [ { "name": "VA Boston Healthcare System, West Roxbury, MA 02132, USA" } ], "family": "Chen", "given": "Anna", "sequence": "additional" }, { "affiliation": [ { "name": "VA Boston Healthcare System, West Roxbury, MA 02132, USA" }, { "name": "Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02111, USA" } ], "family": "Linsenmeyer", "given": "Katherine", "sequence": "additional" }, { "affiliation": [ { "name": "VA Boston Healthcare System, West Roxbury, MA 02132, USA" } ], "family": "Madjarov", "given": "Rebecca", "sequence": "additional" }, { "ORCID": "https://orcid.org/0000-0002-3301-8966", "affiliation": [ { "name": "VA Boston Healthcare System, West Roxbury, MA 02132, USA" }, { "name": "Department of Neurology, Harvard Medical School, Boston, MA 02115, USA" }, { "name": "Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02111, USA" } ], "authenticated-orcid": false, "family": "Charness", "given": "Michael E.", "sequence": "additional" } ], "container-title": "Infectious Disease Reports", "container-title-short": "Infectious Disease Reports", "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2025, 5, 1 ] ], "date-time": "2025-05-01T13:16:12Z", "timestamp": 1746105372000 }, "deposited": { "date-parts": [ [ 2025, 5, 1 ] ], "date-time": "2025-05-01T14:13:38Z", "timestamp": 1746108818000 }, "indexed": { "date-parts": [ [ 2025, 5, 2 ] ], "date-time": "2025-05-02T04:09:40Z", "timestamp": 1746158980536, "version": "3.40.4" }, "is-referenced-by-count": 0, "issue": "3", "issued": { "date-parts": [ [ 2025, 5, 1 ] ] }, "journal-issue": { "issue": "3", "published-online": { "date-parts": [ [ 2025, 6 ] ] } }, "language": "en", "license": [ { "URL": "https://creativecommons.org/licenses/by/4.0/", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2025, 5, 1 ] ], "date-time": "2025-05-01T00:00:00Z", "timestamp": 1746057600000 } } ], "link": [ { "URL": "https://www.mdpi.com/2036-7449/17/3/43/pdf", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "1968", "original-title": [], "page": "43", "prefix": "10.3390", "published": { "date-parts": [ [ 2025, 5, 1 ] ] }, "published-online": { "date-parts": [ [ 2025, 5, 1 ] ] }, "publisher": "MDPI AG", "reference": [ { "DOI": "10.1056/NEJMc2206449", "article-title": "Rebound of SARS-CoV-2 Infection after Nirmatrelvir-Ritonavir Treatment", "author": "Charness", "doi-asserted-by": "crossref", "first-page": "1045", "journal-title": "N. 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