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News
Longer Paxlovid doesn't help long COVID, trial finds. A large US randomized controlled trial published in The Lancet Infectious Diseases found that taking Paxlovid for up to 25 days offered no significant improvement in cognitive issues, autonomic symptoms, or exercise intolerance in long-COVID patients. The findings challenge the viral persistence theory as a primary driver of long COVID.
A phase 2 randomized controlled trial — the RECOVER-VITAL study — found that extending Paxlovid (nirmatrelvir–ritonavir) treatment to 25 days provided no meaningful benefit for adults suffering from long COVID. Published in The Lancet Infectious Diseases, the study tested whether a longer antiviral course could eliminate lingering SARS-CoV-2 thought to drive persistent symptoms — a theory known as viral persistence.
The double-blind trial enrolled 959 adults across 69 US medical centers, dividing participants into three symptom groups: cognitive dysfunction, autonomic symptoms (e.g., dizziness, shortness of breath), and exercise intolerance. No statistically significant improvements were seen in any group compared to placebo. Notably, a large proportion of participants improved regardless of treatment, raising concerns about the Hawthorne effect inflating perceived benefit in uncontrolled studies.
Key Takeaways:
Why it matters: These findings deal a significant blow to the viral persistence hypothesis as a treatment target, signaling that clinicians should not extend Paxlovid courses for long-COVID patients and that researchers must rethink therapeutic strategies for this condition.
