Nirmatrelvir–ritonavir versus placebo–ritonavir in individuals with long COVID in the USA (PAX LC): a double-blind, randomised, placebo-controlled, phase 2, decentralised trial
et al., The Lancet Infectious Diseases, doi:10.1016/S1473-3099(25)00073-8, PAX LC, NCT05668091, Aug 2025
RCT 100 outpatients with long COVID showing no significant difference with paxlovid. Authors hypothesize that viral reservoirs may have been inaccessible to the drug, or that the dose or duration may have been insufficient to eliminate persistent virus.
Standard of Care (SOC) for COVID-19 in the study country,
the USA, is very poor with very low average efficacy for approved treatments1.
Only expensive, high-profit treatments were approved for early treatment. Low-cost treatments were excluded, reducing the probability of early treatment due to access and cost barriers, and eliminating complementary and synergistic benefits seen with many low-cost treatments.
|
risk of long COVID, 124.4% higher, RR 2.24, p = 0.56, treatment mean 0.45 (±4.93) n=49, control mean 1.01 (±4.75) n=51, relative PROMIS-29 improvement, primary outcome.
|
| Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates |
Sawano et al., 31 Aug 2025, Double Blind Randomized Controlled Trial, placebo-controlled, USA, peer-reviewed, mean age 42.0, 27 authors, study period 14 April, 2023 - 26 February, 2024, trial NCT05668091 (history) (PAX LC).
Contact: harlan.krumholz@yale.edu.
Nirmatrelvir–ritonavir versus placebo–ritonavir in individuals with long COVID in the USA (PAX LC): a double-blind, randomised, placebo-controlled, phase 2, decentralised trial
The Lancet Infectious Diseases, doi:10.1016/s1473-3099(25)00073-8
Background The substantial burden of post-COVID-19 condition (also known as long COVID) underscores the need for effective pharmacological interventions. Given that viral persistence has been hypothesised as a potential cause of long COVID, antiviral therapy might offer a promising approach to alleviating long COVID symptoms. We therefore investigated the efficacy, safety, and tolerability of nirmatrelvir-ritonavir for treating long COVID.
Methods In this phase 2, decentralised, double-blind, randomised controlled trial, adults (aged ≥18 years) from the 48 states across the contiguous USA, with previous documented SARS-CoV-2 infection and long COVID symptoms starting within 4 weeks of initial infection and persisting for at least 12 weeks, were eligible for inclusion. Key exclusion criteria were use of nirmatrelvir-ritonavir within the previous 2 months, CYP3A4-dependent medications, or strong CYP3A4 inducers; acute medical illness such as SARS-CoV-2 infection within the past 2 weeks; active liver disease; renal impairment; and immunocompromise. Using software for 1:1 stratified block random assignment, participants were randomly allocated to receive either two tablets of nirmatrelvir (150 mg each) and one tablet of ritonavir (100 mg), or placebo and one tablet of ritonavir (100 mg), orally administered twice daily for 15 days, stratified by age, sex at birth, and COVID-19 vaccination status. Participants, clinicians, and the study team were masked to treatment allocation. The primary efficacy endpoint was the change in the Patient-Reported Outcomes Measurement Information System (PROMIS)-29 Physical Health Summary Score (PHSS) from baseline to day 28, analysed by intention to treat. Safety endpoints were reported from baseline to week 6 in all participants who were exposed to the study treatment. This trial is registered with ClinicalTrials.gov (NCT05668091) and is now closed to new participants. Findings Between April 14, 2023, and Feb 26, 2024, 119 participants were screened. 100 were enrolled (66 [66%] female participants and 34 [34%] male participants), with 49 assigned to the nirmatrelvir-ritonavir group and 51 to the placebo-ritonavir group (intention-to-treat population). Three participants in the nirmatrelvir-ritonavir group and two in the placebo-ritonavir group withdrew before starting treatment and were excluded from the safety population. The mean PROMIS-29 PHSS at baseline was 39•6 (95% CI 37•4 to 41•9) in the nirmatrelvir-ritonavir group and 36•3 (34•4 to 38•2) in the placebo-ritonavir group. The adjusted change from baseline to day 28 was 0•45 (-0•93 to 1•83) in the nirmatrelvir-ritonavir group and 1•01 (-0•30 to 2•31) in the placebo-ritonavir group (adjusted mean difference -0•55 [95% CI -2•32 to 1•21; p=0•54]). No deaths or serious adverse events were recorded between baseline and week 6. Study drug-related treatment-emergent adverse events were reported in more participants in the nirmatrelvir-ritonavir group (35 [76%] of 46)..
Data are n (%) or mean (SD), unless otherwise stated. FACIT=Functional Assessment of Chronic Illness Therapy. TEAE=treatment-emergent adverse event. *Severity was determined subjectively by physician-study investigators by reviewing contents from the e-diaries and notes from conversations that occurred between patient and study coordinator. In general, mild was used for symptoms that did not necessitate any intervention and did not result in significant reduction in quality of life; moderate was used for symptoms that necessitated some symptom-alleviating medication or other measures that resulted in moderate reduction in quality of life with possibly a visit to the health-care provider office (but not emergency department visit or hospitalisation); and severe was used for symptoms that resulted in an emergency department visit or hospitalisation. †Nirmatrelvir concentrations were measured once in both groups between day 7 and day 14 as part of the at-home biospecimen collection. A few samples were not analysable due to poor sample condition (nirmatrelvir-ritonavir n=7; placebo-ritonavir n=6). All 45 placebo group samples included had values <10 ng/mL, which is the lower limit of quantification of the assay, and among the 42 analysed from the nirmatrelvir-ritonavir group, the range varied between 158 ng/mL and 7520 ng/mL.
References
Adjaye-Gbewonyo, Vahratian, Perrine, Bertolli, Long COVID in adults: United States, 2022, NCHS Data Brief
Al-Aly, Davis, Mccorkell, Long COVID science, research and policy, Nat Med
Bonet, Vélez, Jordà, Treatment of COVID-19 during the acute phase in hospitalized patients decreases post-acute sequelae of COVID-19, J Clin Med
Ceulemans, Khan, Yoo, Persistence of SARS-CoV-2 RNA in lung tissue after mild COVID-19, Lancet Respir Med
Davis, Mccorkell, Vogel, Topol, Long COVID: major findings, mechanisms and recommendations, Nat Rev Microbiol
Detry, Ma, Analyzing repeated measurements using mixed models, JAMA
Facit, Org, FACIT item GP5: functional assessment of chronic illness therapy -item GP5
Fallon, Zubcevik, Bennett, The General Symptom Questionnaire-30 (GSQ-30): a brief measure of multi-system symptom burden in Lyme disease, Front Med
Gaebler, Wang, Lorenzi, Evolution of antibody immunity to SARS-CoV-2, Nature
Geng, Bonilla, Hedlin, Nirmatrelvir-ritonavir and symptoms in adults with postacute sequelae of SARS-CoV-2 infection: the STOP-PASC randomized clinical trial, JAMA Intern Med
Group, EuroQol-a new facility for the measurement of health-related quality of life, Health Policy
Guy, ECDEU assessment manual for psychopharmacology
Hammond, Leister-Tebbe, Gardner, Oral nirmatrelvir for high-risk, nonhospitalized adults with COVID-19, N Engl J Med
Harris, Holmes, Gbinigie-Thompson, Health outcomes 3 months and 6 months after molnupiravir treatment for COVID-19 for people at higher risk in the community (PANORAMIC): a randomised controlled trial, Lancet Infect Dis
Hays, Spritzer, Schalet, Cella, PROMIS-29 v2.0 profile physical and mental health summary scores, Qual Life Res
Hughes, Haroon, Subramanian, Development and validation of the symptom burden questionnaire for long COVID (SBQ-LC): rasch analysis, BMJ
Ioannou, Berry, Rajeevan, Effectiveness of nirmatrelvir-ritonavir against the development of post-COVID-19 conditions among US veterans: a target trial emulation, Ann Intern Med
Krumholz, Sawano, Bhattacharjee, The PAX LC trial: a decentralized, phase 2, randomized, double-blind study of nirmatrelvir/ritonavir compared with placebo/ritonavir for long COVID, Am J Med, doi:10.1016/j.amjmed.2024.04.030
Littell, Milliken, Stroup, Wolfinger, Schabenberger, SAS for mixed models
Nevalainen, Horstia, Laakkonen, Effect of remdesivir post hospitalization for COVID-19 infection from the randomized SOLIDARITY Finland trial, Nat Commun
Pintos-Pascual, Moreno-Torres, Ibánez-Estéllez, Is SARS-CoV-2 the only cause of long-COVID?, AIDS Rev
Proal, Vanelzakker, Aleman, SARS-CoV-2 reservoir in post-acute sequelae of COVID-19 (PASC), Nat Immunol
Sawano, Warner, Henriquez, Bhattacharjee, Iwasaki et al., Demographic representation of a decentralized long COVID trial: a comparison with the 2023 National Health Interview Survey, medRxiv, doi:10.1101/2024.11.25.24317941
Sawano, Wu, Shah, Long COVID characteristics and experience: a descriptive study from the Yale LISTEN research cohort, Am J Med, doi:10.1016/j.amjmed.2024.04.015
Sevrioukova, Poulos, Structure and mechanism of the complex between cytochrome P4503A4 and ritonavir, Proc Natl Acad Sci
Tejerina, Catalan, Rodriguez-Grande, Post-COVID-19 syndrome. SARS-CoV-2 RNA detection in plasma, stool, and urine in patients with persistent symptoms after COVID-19, BMC Infect Dis
Tong, Baumgart, Evangelidis, Core outcome measures for trials in people with coronavirus disease 2019: respiratory failure, multiorgan failure, shortness of breath, and recovery, Crit Care Med
Wu, Sawano, Wu, Factors associated with long COVID: insights from two nationwide surveys, Am J Med
Xie, Choi, Al-Aly, Association of treatment with nirmatrelvir and the risk of post-COVID-19 condition, JAMA Intern Med
Yale, Bristol Myers, Squibb, Nordisk, Peripheral Artery Questionnaire and serves on the board of directors for Blue Cross Blue Shield of Kansas City, MO, USA. AI co-founded RIGImmune, Xanadu Bio, and PanV, and is a member of the Board of Directors of Roche Holding and Genentech
Zhou, Sawano, Arun, Internal tremors and vibrations in long COVID: a cross-sectional study, Am J Med, doi:10.1016/j.amjmed.2024.07.008
DOI record:
{
"DOI": "10.1016/s1473-3099(25)00073-8",
"ISSN": [
"1473-3099"
],
"URL": "http://dx.doi.org/10.1016/S1473-3099(25)00073-8",
"alternative-id": [
"S1473309925000738"
],
"assertion": [
{
"label": "This article is maintained by",
"name": "publisher",
"value": "Elsevier"
},
{
"label": "Article Title",
"name": "articletitle",
"value": "Nirmatrelvir–ritonavir versus placebo–ritonavir in individuals with long COVID in the USA (PAX LC): a double-blind, randomised, placebo-controlled, phase 2, decentralised trial"
},
{
"label": "Journal Title",
"name": "journaltitle",
"value": "The Lancet Infectious Diseases"
},
{
"label": "CrossRef DOI link to publisher maintained version",
"name": "articlelink",
"value": "https://doi.org/10.1016/S1473-3099(25)00073-8"
},
{
"label": "CrossRef DOI link to the associated document",
"name": "associatedlink",
"value": "https://doi.org/10.1016/S1473-3099(25)00208-7"
},
{
"label": "Content Type",
"name": "content_type",
"value": "article"
},
{
"label": "Copyright",
"name": "copyright",
"value": "© 2025 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies."
}
],
"author": [
{
"affiliation": [],
"family": "Sawano",
"given": "Mitsuaki",
"sequence": "first"
},
{
"affiliation": [],
"family": "Bhattacharjee",
"given": "Bornali",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Caraballo",
"given": "César",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Khera",
"given": "Rohan",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Li",
"given": "Shu-Xia",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Herrin",
"given": "Jeph",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Christian",
"given": "Dany",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Coppi",
"given": "Andreas",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Warner",
"given": "Frederick",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Holub",
"given": "Julie",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Henriquez",
"given": "Yashira",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Johnson",
"given": "Maria A",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Goddard",
"given": "Theresa B",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Rocco",
"given": "Erica",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Hummel",
"given": "Amy C",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Mouslmani",
"given": "Mohammad AL",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Hooper",
"given": "William Brenham",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Putrino",
"given": "David F",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Carr",
"given": "Kevin D",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Charnas",
"given": "Lawrence",
"sequence": "additional"
},
{
"affiliation": [],
"family": "De Jesus",
"given": "Magdia",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Nepert",
"given": "Dale",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Abreu",
"given": "Paula",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Ziegler",
"given": "Frank W",
"sequence": "additional",
"suffix": "3rd"
},
{
"affiliation": [],
"family": "Spertus",
"given": "John A",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Iwasaki",
"given": "Akiko",
"sequence": "additional"
},
{
"affiliation": [],
"family": "Krumholz",
"given": "Harlan M",
"sequence": "additional"
}
],
"container-title": "The Lancet Infectious Diseases",
"container-title-short": "The Lancet Infectious Diseases",
"content-domain": {
"crossmark-restriction": true,
"domain": [
"clinicalkey.com",
"clinicalkey.com.au",
"clinicalkey.es",
"clinicalkey.fr",
"clinicalkey.jp",
"em-consulte.com",
"thelancet.com",
"elsevier.com",
"sciencedirect.com"
]
},
"created": {
"date-parts": [
[
2025,
4,
5
]
],
"date-time": "2025-04-05T23:17:47Z",
"timestamp": 1743895067000
},
"deposited": {
"date-parts": [
[
2025,
7,
23
]
],
"date-time": "2025-07-23T22:41:00Z",
"timestamp": 1753310460000
},
"funder": [
{
"DOI": "10.13039/100004319",
"award": [
"76768419"
],
"doi-asserted-by": "publisher",
"id": [
{
"asserted-by": "publisher",
"id": "10.13039/100004319",
"id-type": "DOI"
}
],
"name": "Pfizer"
},
{
"DOI": "10.13039/100013043",
"doi-asserted-by": "publisher",
"id": [
{
"asserted-by": "publisher",
"id": "10.13039/100013043",
"id-type": "DOI"
}
],
"name": "Yale Center for Clinical Investigation"
}
],
"indexed": {
"date-parts": [
[
2025,
11,
8
]
],
"date-time": "2025-11-08T13:55:27Z",
"timestamp": 1762610127701,
"version": "3.41.2"
},
"is-referenced-by-count": 11,
"issue": "8",
"issued": {
"date-parts": [
[
2025,
8
]
]
},
"journal-issue": {
"issue": "8",
"published-print": {
"date-parts": [
[
2025,
8
]
]
}
},
"language": "en",
"license": [
{
"URL": "https://www.elsevier.com/tdm/userlicense/1.0/",
"content-version": "tdm",
"delay-in-days": 0,
"start": {
"date-parts": [
[
2025,
8,
1
]
],
"date-time": "2025-08-01T00:00:00Z",
"timestamp": 1754006400000
}
},
{
"URL": "https://www.elsevier.com/legal/tdmrep-license",
"content-version": "tdm",
"delay-in-days": 0,
"start": {
"date-parts": [
[
2025,
8,
1
]
],
"date-time": "2025-08-01T00:00:00Z",
"timestamp": 1754006400000
}
},
{
"URL": "https://doi.org/10.15223/policy-017",
"content-version": "stm-asf",
"delay-in-days": 0,
"start": {
"date-parts": [
[
2025,
8,
1
]
],
"date-time": "2025-08-01T00:00:00Z",
"timestamp": 1754006400000
}
},
{
"URL": "https://doi.org/10.15223/policy-037",
"content-version": "stm-asf",
"delay-in-days": 0,
"start": {
"date-parts": [
[
2025,
8,
1
]
],
"date-time": "2025-08-01T00:00:00Z",
"timestamp": 1754006400000
}
},
{
"URL": "https://doi.org/10.15223/policy-012",
"content-version": "stm-asf",
"delay-in-days": 0,
"start": {
"date-parts": [
[
2025,
8,
1
]
],
"date-time": "2025-08-01T00:00:00Z",
"timestamp": 1754006400000
}
},
{
"URL": "https://doi.org/10.15223/policy-029",
"content-version": "stm-asf",
"delay-in-days": 0,
"start": {
"date-parts": [
[
2025,
8,
1
]
],
"date-time": "2025-08-01T00:00:00Z",
"timestamp": 1754006400000
}
},
{
"URL": "https://doi.org/10.15223/policy-004",
"content-version": "stm-asf",
"delay-in-days": 0,
"start": {
"date-parts": [
[
2025,
8,
1
]
],
"date-time": "2025-08-01T00:00:00Z",
"timestamp": 1754006400000
}
}
],
"link": [
{
"URL": "https://api.elsevier.com/content/article/PII:S1473309925000738?httpAccept=text/xml",
"content-type": "text/xml",
"content-version": "vor",
"intended-application": "text-mining"
},
{
"URL": "https://api.elsevier.com/content/article/PII:S1473309925000738?httpAccept=text/plain",
"content-type": "text/plain",
"content-version": "vor",
"intended-application": "text-mining"
}
],
"member": "78",
"original-title": [],
"page": "936-946",
"prefix": "10.1016",
"published": {
"date-parts": [
[
2025,
8
]
]
},
"published-print": {
"date-parts": [
[
2025,
8
]
]
},
"publisher": "Elsevier BV",
"reference": [
{
"article-title": "Long COVID in adults: United States, 2022",
"author": "Adjaye-Gbewonyo",
"first-page": "1",
"journal-title": "NCHS Data Brief",
"key": "10.1016/S1473-3099(25)00073-8_bib1",
"volume": "480",
"year": "2023"
},
{
"article-title": "Long COVID characteristics and experience: a descriptive study from the Yale LISTEN research cohort",
"author": "Sawano",
"journal-title": "Am J Med",
"key": "10.1016/S1473-3099(25)00073-8_bib2",
"year": "2024"
},
{
"DOI": "10.3390/jcm12124158",
"article-title": "Treatment of COVID-19 during the acute phase in hospitalized patients decreases post-acute sequelae of COVID-19",
"author": "Badenes Bonet",
"doi-asserted-by": "crossref",
"journal-title": "J Clin Med",
"key": "10.1016/S1473-3099(25)00073-8_bib3",
"volume": "12",
"year": "2023"
},
{
"DOI": "10.1038/s41579-022-00846-2",
"article-title": "Long COVID: major findings, mechanisms and recommendations",
"author": "Davis",
"doi-asserted-by": "crossref",
"first-page": "133",
"journal-title": "Nat Rev Microbiol",
"key": "10.1016/S1473-3099(25)00073-8_bib4",
"volume": "21",
"year": "2023"
},
{
"article-title": "Is SARS-CoV-2 the only cause of long-COVID?",
"author": "Pintos-Pascual",
"first-page": "183",
"journal-title": "AIDS Rev",
"key": "10.1016/S1473-3099(25)00073-8_bib5",
"volume": "24",
"year": "2022"
},
{
"DOI": "10.1038/s41590-023-01601-2",
"article-title": "SARS-CoV-2 reservoir in post-acute sequelae of COVID-19 (PASC)",
"author": "Proal",
"doi-asserted-by": "crossref",
"first-page": "1616",
"journal-title": "Nat Immunol",
"key": "10.1016/S1473-3099(25)00073-8_bib6",
"volume": "24",
"year": "2023"
},
{
"DOI": "10.1016/S1473-3099(24)00431-6",
"article-title": "Health outcomes 3 months and 6 months after molnupiravir treatment for COVID-19 for people at higher risk in the community (PANORAMIC): a randomised controlled trial",
"author": "Harris",
"doi-asserted-by": "crossref",
"first-page": "68",
"journal-title": "Lancet Infect Dis",
"key": "10.1016/S1473-3099(25)00073-8_bib7",
"volume": "25",
"year": "2024"
},
{
"DOI": "10.7326/M23-1394",
"article-title": "Effectiveness of nirmatrelvir–ritonavir against the development of post-COVID-19 conditions among US veterans: a target trial emulation",
"author": "Ioannou",
"doi-asserted-by": "crossref",
"first-page": "1486",
"journal-title": "Ann Intern Med",
"key": "10.1016/S1473-3099(25)00073-8_bib8",
"volume": "176",
"year": "2023"
},
{
"DOI": "10.1038/s41467-022-33825-5",
"article-title": "Effect of remdesivir post hospitalization for COVID-19 infection from the randomized SOLIDARITY Finland trial",
"author": "Nevalainen",
"doi-asserted-by": "crossref",
"journal-title": "Nat Commun",
"key": "10.1016/S1473-3099(25)00073-8_bib9",
"volume": "13",
"year": "2022"
},
{
"DOI": "10.1001/jamainternmed.2023.0743",
"article-title": "Association of treatment with nirmatrelvir and the risk of post-COVID-19 condition",
"author": "Xie",
"doi-asserted-by": "crossref",
"first-page": "554",
"journal-title": "JAMA Intern Med",
"key": "10.1016/S1473-3099(25)00073-8_bib10",
"volume": "183",
"year": "2023"
},
{
"DOI": "10.1056/NEJMoa2118542",
"article-title": "Oral nirmatrelvir for high-risk, nonhospitalized adults with COVID-19",
"author": "Hammond",
"doi-asserted-by": "crossref",
"first-page": "1397",
"journal-title": "N Engl J Med",
"key": "10.1016/S1473-3099(25)00073-8_bib11",
"volume": "386",
"year": "2022"
},
{
"DOI": "10.1001/jamainternmed.2024.2007",
"article-title": "Nirmatrelvir–ritonavir and symptoms in adults with postacute sequelae of SARS-CoV-2 infection: the STOP-PASC randomized clinical trial",
"author": "Geng",
"doi-asserted-by": "crossref",
"first-page": "1024",
"journal-title": "JAMA Intern Med",
"key": "10.1016/S1473-3099(25)00073-8_bib12",
"volume": "184",
"year": "2024"
},
{
"article-title": "The PAX LC trial: a decentralized, phase 2, randomized, double-blind study of nirmatrelvir/ritonavir compared with placebo/ritonavir for long COVID",
"author": "Krumholz",
"journal-title": "Am J Med",
"key": "10.1016/S1473-3099(25)00073-8_bib13",
"year": "2024"
},
{
"DOI": "10.1073/pnas.1010693107",
"article-title": "Structure and mechanism of the complex between cytochrome P4503A4 and ritonavir",
"author": "Sevrioukova",
"doi-asserted-by": "crossref",
"first-page": "18",
"journal-title": "Proc Natl Acad Sci USA",
"key": "10.1016/S1473-3099(25)00073-8_bib14",
"volume": "107",
"year": "2010"
},
{
"DOI": "10.1007/s11136-018-1842-3",
"article-title": "PROMIS-29 v2.0 profile physical and mental health summary scores",
"author": "Hays",
"doi-asserted-by": "crossref",
"first-page": "1885",
"journal-title": "Qual Life Res",
"key": "10.1016/S1473-3099(25)00073-8_bib15",
"volume": "27",
"year": "2018"
},
{
"DOI": "10.3389/fmed.2019.00283",
"article-title": "The General Symptom Questionnaire-30 (GSQ-30): a brief measure of multi-system symptom burden in Lyme disease",
"author": "Fallon",
"doi-asserted-by": "crossref",
"first-page": "283",
"journal-title": "Front Med",
"key": "10.1016/S1473-3099(25)00073-8_bib16",
"volume": "6",
"year": "2019"
},
{
"DOI": "10.1097/CCM.0000000000004817",
"article-title": "Core outcome measures for trials in people with coronavirus disease 2019: respiratory failure, multiorgan failure, shortness of breath, and recovery",
"author": "Tong",
"doi-asserted-by": "crossref",
"first-page": "503",
"journal-title": "Crit Care Med",
"key": "10.1016/S1473-3099(25)00073-8_bib17",
"volume": "49",
"year": "2021"
},
{
"DOI": "10.1016/0168-8510(90)90421-9",
"article-title": "EuroQol—a new facility for the measurement of health-related quality of life",
"doi-asserted-by": "crossref",
"first-page": "199",
"journal-title": "Health Policy",
"key": "10.1016/S1473-3099(25)00073-8_bib18",
"volume": "16",
"year": "1990"
},
{
"author": "Guy",
"key": "10.1016/S1473-3099(25)00073-8_bib20",
"series-title": "ECDEU assessment manual for psychopharmacology",
"year": "1976"
},
{
"article-title": "Internal tremors and vibrations in long COVID: a cross-sectional study",
"author": "Zhou",
"journal-title": "Am J Med",
"key": "10.1016/S1473-3099(25)00073-8_bib21",
"year": "2024"
},
{
"DOI": "10.1001/jama.2015.19394",
"article-title": "Analyzing repeated measurements using mixed models",
"author": "Detry",
"doi-asserted-by": "crossref",
"first-page": "407",
"journal-title": "JAMA",
"key": "10.1016/S1473-3099(25)00073-8_bib22",
"volume": "315",
"year": "2016"
},
{
"author": "Littell",
"key": "10.1016/S1473-3099(25)00073-8_bib23",
"series-title": "SAS for mixed models",
"year": "2006"
},
{
"DOI": "10.1016/S2213-2600(21)00240-X",
"article-title": "Persistence of SARS-CoV-2 RNA in lung tissue after mild COVID-19",
"author": "Ceulemans",
"doi-asserted-by": "crossref",
"first-page": "e78",
"journal-title": "Lancet Respir Med",
"key": "10.1016/S1473-3099(25)00073-8_bib24",
"volume": "9",
"year": "2021"
},
{
"DOI": "10.1038/s41586-021-03207-w",
"article-title": "Evolution of antibody immunity to SARS-CoV-2",
"author": "Gaebler",
"doi-asserted-by": "crossref",
"first-page": "639",
"journal-title": "Nature",
"key": "10.1016/S1473-3099(25)00073-8_bib25",
"volume": "591",
"year": "2021"
},
{
"DOI": "10.1186/s12879-022-07153-4",
"article-title": "Post-COVID-19 syndrome. SARS-CoV-2 RNA detection in plasma, stool, and urine in patients with persistent symptoms after COVID-19",
"author": "Tejerina",
"doi-asserted-by": "crossref",
"first-page": "211",
"journal-title": "BMC Infect Dis",
"key": "10.1016/S1473-3099(25)00073-8_bib26",
"volume": "22",
"year": "2022"
},
{
"DOI": "10.1038/s41591-024-03173-6",
"article-title": "Long COVID science, research and policy",
"author": "Al-Aly",
"doi-asserted-by": "crossref",
"first-page": "2148",
"journal-title": "Nat Med",
"key": "10.1016/S1473-3099(25)00073-8_bib27",
"volume": "30",
"year": "2024"
},
{
"article-title": "Demographic representation of a decentralized long COVID trial: a comparison with the 2023 National Health Interview Survey",
"author": "Sawano",
"journal-title": "medRxiv",
"key": "10.1016/S1473-3099(25)00073-8_bib28",
"year": "2024"
},
{
"DOI": "10.1016/j.amjmed.2024.02.032",
"article-title": "Factors associated with long COVID: insights from two nationwide surveys",
"author": "Wu",
"doi-asserted-by": "crossref",
"first-page": "515",
"journal-title": "Am J Med",
"key": "10.1016/S1473-3099(25)00073-8_bib29",
"volume": "137",
"year": "2024"
},
{
"article-title": "Development and validation of the symptom burden questionnaire for long COVID (SBQ-LC): rasch analysis",
"author": "Hughes",
"journal-title": "BMJ",
"key": "10.1016/S1473-3099(25)00073-8_bib30",
"volume": "377",
"year": "2022"
}
],
"reference-count": 29,
"references-count": 29,
"relation": {},
"resource": {
"primary": {
"URL": "https://linkinghub.elsevier.com/retrieve/pii/S1473309925000738"
}
},
"score": 1,
"short-title": [],
"source": "Crossref",
"subject": [],
"subtitle": [],
"title": "Nirmatrelvir–ritonavir versus placebo–ritonavir in individuals with long COVID in the USA (PAX LC): a double-blind, randomised, placebo-controlled, phase 2, decentralised trial",
"type": "journal-article",
"update-policy": "https://doi.org/10.1016/elsevier_cm_policy",
"volume": "25"
}
Late treatment
is less effective
is less effective
