Who should take Paxlovid? Why isn’t it for everyone?

IIt is increasingly difficult to avoid COVID-19, thanks to BA.5’s dominance in the US and more and more Omicron sub-variable. Fortunately, Paxlovid’s antiviral drug Pfizer can minimize illness from the disease.

But it’s not for everyone. Only people at high risk of severe illness from COVID-19 are eligible for the drug, including people over 12 with weakened immune systems or others. health condition increases your risk of severe effects of COVID-19 — such as asthma, cancer, liver disease, lung disease, heart disease, and obesity. Paxlovid also comes with a list of possible side effects with common medications, such as cholesterol-lowering statins.

Because the drug is not approved by the U.S. Food and Drug Administration but is authorized for emergency use, doctors are generally unable to prescribe drugs outside of the allowable criteria. However, that doesn’t stop people of all ages and risk profiles from claiming Paxlovid, from hard to find to more accessible in just a few months. From December 2021, when Paxlovid was authorized, to June 2022, prescriptions for the drug increased from 2,500 to nearly 1 million in the US, according to data provided to TIME by medical data company Iqvia.

Here’s what prescribers have to say about who should get their Paxlovid shot at this time during the pandemic.

Those at high risk benefit more

Learn conducted by Pfizer before Paxlovid was authorized, found that the drug reduced the risk of hospitalization and death by up to 89% in unvaccinated people at high risk of a bad COVID-19 outcome. That effect has become less impressive as vaccinations have increased: the company’s latest data shows Paxlovid 57% effective in achieving these results in vaccinated individuals who have a lower risk of severe disease, such as those with at least one of the Risk factors increases your risk of severe COVID-19 illness.

Other data that Pfizer released in June showed that the drug did not significantly reduce the number of symptoms in people with any immunization status who were at average risk of severe illness, compared with those who did not take the drug. “That data changed the way I view the drug, which was once hailed as a game changer,” said Dr Anand Viswanathan, assistant professor of medicine at NYU Langone Health.

Even after the drug was approved by the U.S. Food and Drug Administration (FDA) in December 2021, supplies remained tight, but the Biden Administration increased awareness and access to the drug. Paxlovid in March by announcing Test program for treatment, which allows people to test at places like pharmacies and get prescriptions on the spot if they’re positive. The drug’s supply increased in the spring, and it went from being under-prescribed (to stock up on limited supplies for those most at risk) to widespread among doctors and patients. On July 7, FDA continues extended access by allowing state-licensed pharmacists to write prescriptions for anyone over the age of 12.

With improved access, some experts believe the drug may now be over-prescribed. Paxlovid remains one of the few FDA-approved COVID-19 antiviral treatments (others include a pill called molnupiravir and remdesivir, an IV therapy) so people are still asking for it. “There may be some overprescribing or prescribing in low-risk populations,” said Dr Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security and an infectious disease physician.

Despite the increasing popularity of this drug, for people who are healthy and not at high risk for severe illness, there is little data to support a benefit of taking an antiviral like Paxlovid. “For the average healthy person – even a 55-year-old with no serious medical problems – they may not benefit and just complain of an unpleasant taste in their mouth,” Adalja said. “. “You have to get back to the primary purpose of prescribing Paxlovid: preventing serious illness, hospitalization, and death.”

Prescription by age

Even for people with symptoms without other health conditions, Adalja usually doesn’t prescribe Paxlovid unless they’re 65 or older. It’s a common metric that doctors are starting to use. But there are no hard and fast rules, even when it comes to age. William Durkin, an emergency physician at Alvarado Medical Center in San Diego, recently decided not to prescribe Paxlovid to an elderly patient who was otherwise healthy and without any symptoms.

For patients who have no symptoms when they test positive, doctors can proactively write prescriptions and ask them to contact them if they develop symptoms for a day or so. Because Paxlovid is most effective if taken within five days of symptoms appearing, having a prescription ready can ensure that people take advantage of the short time it takes to work.

The future of Paxlovid

Used correctly, antivirals like Paxlovid can help slow transmission as highly contagious Omicron variants continue to spread. “We have worked hard with clinicians, community organizations and the public to make people aware that these drugs are available and the importance of knowing your risk factors. for severe COVID-19 disease,” said Dr. Mary Mercer, associate professor of emergency medicine at the University of California San Francisco and San Francisco General Hospital and Trauma Center. By limiting the number of severe illnesses in the community, medicine is another way to control the virus.

If a new variant emerges that is even better at evading vaccine protection and causing more serious illness even among vaccinated people, “Paxlovid could return to the role game changer,” Viswanathan said.

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