Biotech Values

[vinmantoo]

The 3 arms of the "recover-vital" portion of the NIH trial are testing a 25 day regimen of paxlovid, a 15 day regimen with 10 days ritonavir, vs ritonavir plus placebo for 25 days
I have no idea why the 15 day course only has 10 days of booster. Seems like that could be a setup for paxlovid resistance if someone on this regimen contracts covid along the way while being given a subtherapeutic dose. Even the 25 day arm could get infection since the drug failed to prevent transmission in household contacts I guess, but I don't understand giving the virus exposure to low dose of the active agent - i mean that is how resistance is bred in a lab I thought?

It is a bit puzzling and a risk for generating a resistant mutant. My initial thought was that they didn't want to give ritonavir for 25 days but that can't be right because the control arm has ritonavir for 25 days. I guess they are banking on the fact that if there are hidden viral reservoirs the vial titer is so low that would reduce the chances for resistance to arise even with suboptimal Paxlovid levels. As far as contracting Covid during the treatment, again it may be a calculated risk as Covid is at relatively low levels in the population right now. Of course an obvious reason is that there could be a Paxloid toxicity issue to consider in a longer treatment course.