Flawed trial designs lead to trial failures. NIH RECOVER used ritonavir (an antiviral shown to have an effect on SARS-COV2) as a placebo compared to nirmatrelvir+ritonavir. They also only measured specific symptom categories, so if different improvements occurred, they were not measured. Viral load or other markers of viral persistence were not measured. It's possible that with different parameters and a true non-drug placebo this trial could have been a success. It's also possible that Paxlovid could work better in an antiviral combination therapy. In HIV, it takes about 3 months for antivirals to have significant effect, and in FIP (feline coronavirus) about 80-90 days. Other viruses require similar long term treatment durations, meaning a 25 day course is too short by comparison. The only positive result of this doomed from the start trial was monitoring tolerance of Paxlovid for courses up to 25 days. It was well tolerated by participants. I've done up to 30 days of Paxlovid myself, so I'm glad to see a study demonstrate safety in a large cohort.

The opportunity for patients and advocacy groups to submit abstracts for the @ISLCPAIS was not well advertised. I submitted an abstract as soon as I learned of the option by reading a random X reply comment. I was told I was too late for a link or file to be shared. @LongCovidAP's book can be downloaded at longcovidbook.shop I want all the conference attendees to read this. #islcpais Also $150 is too expensive for VOD for patients. We should get access at something like the recap price. Many of us have had extreme hardship and out of pocket medical expenses since 2020. ISLC, if you want patients to participate, you need to engage in clear outreach communication. I understand that you have deadlines, but I am on this app every day and didn't see anything about patient research abstracts until this week.

This is why we never should have used monotherapy for SARS-COV2. Like HIV, the virus can quickly develop resistance against protease inhibitors. Multiple antivirals with different functions, similar to HIV ART, would be wiser. Protease inhibitors could be effective in combination. That is, if the virus isn't already resistant.

My FDA drug repurposing comment submission, which included LCAP's book as an attachment and research citation source: I am writing to advocate for the research and repurposing of antivirals for the treatment of lymphocytopenia due to COVID and Long Covid. Antivirals could possibly benefit other conditions and symptoms from chronic COVID infection/Long Covid, but they have measurably improved my lymphocytes subsets which were deficient after COVID infection starting in 2020. Monoclonal antibodies Evusheld and Pemgarda, plus subcutaneous immuneglobulin infusions, have also improved my immune health and LC symptoms. The antivirals that have helped me are maraviroc 300mg twice daily, Truvada TDF form 1 tablet once daily, Stribild 1 tablet once daily, Paxlovid (as directed but for longer courses such as 20-30 days), and also Tollovid supplement 3 capsules 4 times a day. My attached chart shows my lymphocyte subsets from 2018 prior to COVID to present day. The deficiency began after my infection in 2020 and has resolved with my current combination of Stribild, maraviroc, Pemgarda, Tollovid, and Gammagard immuneglobulin. I take Truvada instead of Stribild during acute COVID infections and take Paxlovid for extended courses. Also attached is LCAP's book A National Treatment and Research Agenda for Long Covid. There are research references cited in the book demonstrating the potential efficacy of the drugs and antibodies I've mentioned here. My doctors believe I have chronic viral reservoirs of SARS-COV2, particularly in my bone marrow due to B cell suppression, that are treated by these antivirals. Long Covid has been neglected by research, dismissed as a fatigue syndrome goven palliative care, but with my case study I believe I demonstrate the potential for lymphocytes subsets as a biomarker and antivirals plus antibodies as long-term therapeutic treatment. Like HIV, we need sensitivity panels and viral detection/load tests, but I believe I have demonstrated an alternative that can be implemented now. Please also consider the other medications and research protocols for LC described in the book. I was an author on this LCAP committee. I took our research one step further with medical oversight and trialed the drugs myself. I believe there are many others out there like myself who would benefit from repurposed HIV antiviral therapy. Thank you for your consideration. I am available for further discussion. See attached file(s): LCAP's book in pdf file format and my lymphocytes subsets/treatment response graph

This is incredibly bad. There may not be a Pemgarda replacement available by the time the 12 month "grace period" is up. That means there won't be any mAbs for COVID. This removes treatments from use for no scientific reason at all: this is political, pretending COVID is over. Molnupiravir isn't a drug I typically endorse, but it was needed for those who couldn't tolerate protease inhibitors like Paxlovid. It was also being used off-label for cats with FIP. Many RAT tests will vanish from the market. If you have a favorite, check its approval status and stock up. I'm not sure whether SARS-COV2 PCR and antibody lab tests will be impacted.