Unfortunately, there really is no data on whether taking Paxlovid & Metformin together is helpful or not. They both have antiviral properties, but that does not necessarily mean that a combo would be better than Paxlovid alone. They both can cause nausea, so that is something to take into consideration.
For high risk folks, Paxlovid is indicated and should be taken as soon as possible. Immunocompromised people can get Pemgarda monoclonal antibodies in advance for pre-exposure prophylaxis. Hopefully, there will be another monoclonal antibody product available soon.
Do you have a source for this statement (I've been looking for this information): "XBB.1.5 COVID vaccine from last fall does not protect against new variants like KP.3 that are circulating now."
Everything I've found claims there's not enough information to confirm this.
It was from pseudovirus studies from Yunlong Cao's lab and from Kei Sato's lab showing prior infection with XBB did not protect against KP.2. Sato's lab showed that "KP.2 is more than 3x more resistant to our current 2023-2024 XBB.1.5 booster."
4/22/24 BioRxiV (Y. Cao): Humoral immunogenicity comparison of XBB and JN.1 in human infections https://buff.ly/3w7F6YW
Yunlong Cao and associates looked at breakthrough infections (BTI) of XBB vs. breakthrough infection with JN.1 as a sort of vaccination against the new subvariants of JN.1+ FLiRT mutations. They found that prior JN.1 infection protected against new JN.1 + FLiRT subvariants like KP.2, but prior XBB infection did not.
KP.3 had the most immune evasion.
4/26/24 BioRxiV (Kei Sato lab): Virological characteristics of the SARS-CoV-2 KP.2 variant https://buff.ly/3Wj2opp
KP.2 = [JN.1 + FLiRT in the spike + V1104L in the spike]
These results suggest that KP.2 is one of the most immune-evading variants to date.
***KP.2 is more than 3x more resistant to our current 2023-2024 XBB.1.5 booster.
As Eric Topol tweeted “If you had a JN.1 infection, you're pretty well protected by neutralizing antibodies. But the booster (directed vs XBB.1.5) isn't providing very good protection against FLiRT variants.”
“Results suggest that future SARS-CoV-2 vaccine efforts might benefit from focusing on the JN.1 lineage instead of XBB to better counter current and emerging variants.”
Significant immune evasion of recently emerged JN.1 sublineages, including JN.1+R346T+F456L, with KP.3 showing the most pronounced decrease in neutralization titers by both XBB and JN.1 BTI sera.
Thank you Dr. Ruth as always for all the actionable information you’ve provided.
Questions:
When considering treatment, is there data comparing the efficacy between Paxlovid & Metformin?
Can both medications be taken at the same time?
If so, is it advisable for those at high risk?
💜💜💜
Hi Mary,
Unfortunately, there really is no data on whether taking Paxlovid & Metformin together is helpful or not. They both have antiviral properties, but that does not necessarily mean that a combo would be better than Paxlovid alone. They both can cause nausea, so that is something to take into consideration.
For high risk folks, Paxlovid is indicated and should be taken as soon as possible. Immunocompromised people can get Pemgarda monoclonal antibodies in advance for pre-exposure prophylaxis. Hopefully, there will be another monoclonal antibody product available soon.
Do you have a source for this statement (I've been looking for this information): "XBB.1.5 COVID vaccine from last fall does not protect against new variants like KP.3 that are circulating now."
Everything I've found claims there's not enough information to confirm this.
It was from pseudovirus studies from Yunlong Cao's lab and from Kei Sato's lab showing prior infection with XBB did not protect against KP.2. Sato's lab showed that "KP.2 is more than 3x more resistant to our current 2023-2024 XBB.1.5 booster."
4/22/24 BioRxiV (Y. Cao): Humoral immunogenicity comparison of XBB and JN.1 in human infections https://buff.ly/3w7F6YW
Yunlong Cao and associates looked at breakthrough infections (BTI) of XBB vs. breakthrough infection with JN.1 as a sort of vaccination against the new subvariants of JN.1+ FLiRT mutations. They found that prior JN.1 infection protected against new JN.1 + FLiRT subvariants like KP.2, but prior XBB infection did not.
KP.3 had the most immune evasion.
4/26/24 BioRxiV (Kei Sato lab): Virological characteristics of the SARS-CoV-2 KP.2 variant https://buff.ly/3Wj2opp
https://twitter.com/SystemsVirology/status/1784011459036602700
Summary of Tweet by Kei Sato:
KP.2 = [JN.1 + FLiRT in the spike + V1104L in the spike]
These results suggest that KP.2 is one of the most immune-evading variants to date.
***KP.2 is more than 3x more resistant to our current 2023-2024 XBB.1.5 booster.
As Eric Topol tweeted “If you had a JN.1 infection, you're pretty well protected by neutralizing antibodies. But the booster (directed vs XBB.1.5) isn't providing very good protection against FLiRT variants.”
https://twitter.com/EricTopol/status/1783865839714005397
“Results suggest that future SARS-CoV-2 vaccine efforts might benefit from focusing on the JN.1 lineage instead of XBB to better counter current and emerging variants.”
Significant immune evasion of recently emerged JN.1 sublineages, including JN.1+R346T+F456L, with KP.3 showing the most pronounced decrease in neutralization titers by both XBB and JN.1 BTI sera.