Paxlovid may prevent more hospitalisations than its alternatives
The World Health Organization (WHO) April 21, 2022 strongly recommended Pfizer Inc’s COVID-19 pill Paxlovid, a combination of medicines nirmatrelvir and ritonavir, for unvaccinated, older or immunosuppressed patients. The United Nations health agency also conditionally recommended the antiviral medicine remdesivir for the high-risk patient group.
Paxlovid may prevent more hospitalisations than its alternatives, has fewer potential harms than the antiviral drug Molnupiravir and is easier to administer than intravenous options such as remdesivir and antibody treatments, said WHO in its latest guidelines on drugs for treating COVID-19.
The recommendation was based on two randomised controlled trials covering 3,100 patients. It is, however, limited to the high-risk population only since data available till now shows “trivial benefits” for the low-risk population.
Those in the severe stages of the disease are also left out since there is no data that suggests any efficacy of the antiviral at that stage. Studies showed 84 fewer admissions per 1,000 patients in those who took nirmatrelvir / ritonavir based on moderate certainty evidence, according to WHO.
There was low-certainty evidence indicating any change in mortality, while high-certainty evidence was found in chances of patients not developing adverse effects after being administered the drug that could lead to its discontinuation.
The change from recommending remdesivir to all patients irrespective of what stage of disease was based on five randomised trials covering 2,700 people.
WHO said:
The panel noted that antiviral drugs should be administered as early as possible in the course of the disease, and acknowledged some cost and resource implications which may make access to low- and middle-income countries challenging.
Access to these drugs is tied to the access to SARS-CoV-2 diagnostic tests, especially for those targeting the early phase of disease, the body observed.
These living guidelines were developed “to provide trustworthy guidance on the management of COVID-19 and help doctors make better decisions with their patients” by WHO, with support from the MAGIC Evidence Ecosystem Foundation.
Molnupiravir for high-risk patients with non-severe COVID-19 and monoclonal antibody treatments — sotrovimab or casirivimab-imdevimab — in selected patients were the key updates in the previous recommendation of March 3, 2022.
The use of convalescent plasma, ivermectin and hydroxychloroquine — popular choice of treatment in the early stages of the pandemic — remain in the ‘strongly recommended against’ category. Shifting focus from vaccines to antivirals for COVID-19 is the way forward, according to WHO.
The Institute for Health Metrics and Evaluation (IHME), an independent population health research centre at University of Washington Medicine, in its latest pandemic update urged for sharing antivirals to make sure they are available to everyone. This is key in preventing the healthcare system from crumbling in case a wave occurs.
Scaling up antivirals may result in 80-90 per cent fewer deaths from future variants more sevre than omicron, the institute had stated in an update April 8 2022.
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