COVID-19 Update #133 6/2/2022

COVID-19 Vaccines
 
A systematic review and network meta-analysis of 38 WHO COVID-19 databases comprising 53 studies found that a three dose regimen of an mRNA COVID-19 vaccine is most effective for prevention of COVID-19. This includes patients who are immunocompromised and/or older than 65 years.
 
COVID-19 Antivirals
 
The FDA has provided additional information about use of Paxlovid in a 5/4/2022 posting. The FDA addresses reports of rare infection recurrences after completing a course of the drug combination. A re-analysis of Paxlovid data found that while 1-2% of patients may test positive after treatment, it was unclear whether this was a drug effect, because the same results were seen in placebo patients (tested negative, then tested positive). Based on limited information, the CDC found that COVID-19 rebound usually occurs 2 to 8 days after initial recovery and include COVID-19 symptoms or a new positive viral test after having tested negative. The natural course of COVID-19 may include a brief return of symptoms, regardless of treatment or vaccine status. Current cases of rebound COVID-19 rebound after Paxlovid have been mild. There is no evidence to support use of the Paxlovid beyond five days, but the CDC recommends following Guidance on Quarantine and Isolation. 
 
COVID-19 Anti-inflammatories
 
In the 29-day, 1,047 patient, Phase III, ACTT 4 trial (NCT04640168), mechanical ventilation-free survival was similar between baricitinib plus remdesivir and dexamethasone plus remdesivir (87% vs 87.6%) in hospitalized patients with COVID-19. There were more treatment related adverse events and severe or life-threatening adverse events with dexamethasone plus remdesivir.