Amplify the use of Paxlovid. This is the main recommendation recently issued by the Committee for Monitoring and Anticipation of Health Risks (Covars) regarding the treatment of people with Covid-19. What is it based on?
The strategy of the Committee for monitoring and anticipating health risks (Covars, ex-Health Council) is based on four verbs: “Prevent, detect, treat, involve”. If the use of a mask and ventilation are the main recommendations of the prevention section, the chapter on treatment is essentially based on amplifying the use of Paxlovid. But what is it?
Designed by the American laboratory Pfizer (like the Pfzer-BioNTech messenger RNA vaccine), it has been available in France since February 2022, recall the members of Covars, who at the same time deplore an insufficient level of prescribing. However, it is “the only first-line treatment to be used within 5 days of the first signs, whatever the variant of SARS-CoV-2”.
What is his way of acting?
Paxlovid is a drug derived from the combination of the antivirals nirmatrelvir and ritonavir, which “targets the enzyme necessary for viral replication (…) and by inhibiting its action, blocks the replication of SARS-CoV-2 in the body”, explains the Medicines Safety Agency (ANSM).
Its administration is recommended in the first days of infection “to patients over the age of 60 or who have risk factors for a severe form of Covid-19, whatever their age, or who have a severe immunodeficiency that compromises their reply”. Finally, it appears to maintain its effectiveness, regardless of the variant in question.
How has its effectiveness been assessed?
Paxlovid was the subject of a study conducted in the first half of 2022 by EPI-PHARE (scientific interest group ANSM-Cnam) on over 12,000 patients at risk of severe form. He concludes that “the pharmacovigilance data collected (…) confirm the safety profile of the use of Paxlovid”. In addition, Covars points out, “89% risk reduction of hospitalizations and deaths within 28 days” has been demonstrated and confirmed by real-life data in Israel and Hong Kong.
Why isn’t more prescribed?
While safe, Paxlovid treatment is not suitable for all patients: “The management of drug interactions limits its use in patients with organ transplants or chemotherapy, severe renal insufficiency and patients on dialysis,” Covars points out. Who identified other reasons that could explain the underutilization of this treatment: insufficient information for healthcare professionals, perception by healthcare professionals and patients of a minor severity of the Omicron variant, and insufficient availability in pharmacies.
What are the other options?
“Various antiviral monoclonal antibodies are authorized for the early treatment and pre-exposure prophylaxis of severe high-risk patients,” such as immunocompromised patients. But in the face of Omicron variants, the effectiveness of these preventative treatments has significantly diminished. “New antibodies active on the variants are in clinical trials”, specifies the Covars. Which encourages, above all, to “facilitate, amplify, accelerate” the anti-Covid vaccination reminder campaign launched at the beginning of October, in order to reach the target of 18 million eligible persons by the end of the year.