As the coronavirus continues to spread again and kill about 1,500 Americans each week, medical researchers are looking to improve the effectiveness of paxlobid, a drug that is surprisingly effective at preventing severe disease and death from the disease. I'm trying to understand why so few people are doing it.
A study of 1 million people at high risk for COVID-19 found that only about 15% of those eligible for the drug took it. The authors said 48,000 deaths could have been prevented if half of the eligible patients had been vaccinated with paxlobid. the studyconclusions conducted by the National Institutes of Health.
It's not because people don't know about the drug, most people do, but this resistance comes from doctors worried about interactions with other drugs and people wary of the possibility of rebound or a metallic aftertaste. seems to be occurring.
Regional differences provide clues, with support being highest in Democratic strongholds in the Northeast and Pacific Northwest regions of the United States and lowest in deep red states such as Florida and Indiana. But careful research has not yet revealed why so few people took the drug, which reduced the risk of death by 73 percent in high-risk patients in the NIH study.
“We don't know why there is such variation and why intakes aren't higher overall,” said Dr. Josh Fessel, senior clinical advisor to the National Institutes of Health team that studied the drug's use. Ta. “If you can take paxlobid, and you take paxlobid within the recommended period, your chances of death or hospitalization are significantly reduced. That's a big deal.”
The number of deaths from the new coronavirus has increased from about 1,200 to 1,300 per week since September, and rose to about 1,500 per week in December. Researchers say the number of infections is likely to continue rising until more people receive the latest coronavirus vaccines and antiviral treatments.
Dr. Fessel said that throughout the 1 million-person NIH study, about 10% of high-risk patients eligible for paxlobid took paxlobid, but that percentage is expected to increase toward the end of the study period in early 2023. He said it had risen to about 15%. Overall, the NIH authors estimated that about 135,000 hospitalizations and 48,000 deaths could have been avoided if half of the patients eligible for antiviral drugs had received them. ing.
Paxlobid, manufactured by Pfizer, is a two-drug combination therapy that is meant to be taken within five days of the onset of coronavirus symptoms to reduce the spread of the virus in the body. It was approved for adults at high risk for severe coronavirus infection, which tends to include people over 65 and people with diabetes, obesity, asthma and other medical conditions.
There are various reasons for not prescribing or taking drugs. Doctors have balked at the long list of drugs that should not be mixed with paxlobid, including common drugs aimed at lowering blood pressure and preventing blood clots. Patients tend to complain about the metallic aftertaste of the drug. Many people stop taking drugs during the early stages of the coronavirus, when symptoms tend to be the mildest, avoiding the opportunity to limit early virus replication.
“They want to wait and see if things get worse, but waiting doesn't help,” said Dr. David Gifford, chief medical officer of the American Health Care Association, which represents nursing homes. “People think, 'It's just a cold, let's try and get over it,'” he says. “And that needs to change.”
Price is also a factor. The federal government has offered five-day courses of the drug for free for several months since its initial emergency authorization in December 2021 (the Food and Drug Administration fully approved the drug in May). Federal authorities still hold more than 1 million people free of charge. The drugs will be distributed to pharmacies and will be free to Medicaid and Medicare patients until 2024. But in recent weeks, authorities handed over sales of the drug to Pfizer, which priced it at about $1,400 per course, although private insurers are expected to cover part of the price. is suggesting. Subsidy for copayments.
No studies have examined the effects of handoff. The NIH study period ended early last year. It found that there was wide regional variation in paxthrovid use, with up to 50 percent of eligible patients receiving the treatment in Utah and the Northeast and Northwest regions of the United States. . But in some states in the Southeast and the Lower Midwest, interest rates have fallen to near zero.
The NIH's Dr. Fessel said he wanted to know whether concerns about so-called paxlobid rebound were contributing. The fear is that the drug may initially relieve symptoms, but then lead to a second stage of the disease.
recently review The Centers for Disease Control and Prevention found “no consistent association” between paxlobid use and COVID-19 rebound. Research shows that rebound can occur without treatment.
Dennis Nash, a professor of epidemiology at the City University of New York, is also studying the use of paxlobid.far away small studyHer team also found that uptake of the drug was nearly 14%, but lower for some people, such as 7% for Black people and nearly 11% for those at the lowest income levels. .
To dig deeper, he said his team undertook a nationally representative survey of 4,000 people (the results have not yet been published or peer-reviewed). He said one of his interesting findings was that awareness of Paxlovid was high, with about 80% of respondents saying they knew Paxlovid was available.
However, respondents showed a lack of awareness of their own risks. Only about one-third of people 65 and older believed they were at high risk for severe COVID-19 infection, even though the CDC considers everyone in that age group to be at high risk. . The results were similar for patients with asthma and diabetes, but half of those who were overweight or obese were aware of the risk.
“People don't necessarily realize they're at risk,” Dr. Nash says.
another recent research We found that if you start Paxlovid very early, on the first day of symptoms, you have a better chance of survival or avoiding hospitalization compared to starting the drug one to two days later.
Studies are also considering the use of another antiviral drug, molnupiravir, made by Merck & Co., which is less effective and used less frequently. Gilead, which makes the antiviral intravenous solution remdesivir, is also researching a coronavirus antiviral drug called oberdesivir and plans to seek FDA approval. NIH is Further antiviral options under investigationShinogi's encitrelvir also appears to shorten the duration of the illness.
Researchers also report that paxlobid is used less in nursing homes, given the risk that patients face severe illness and death. About one in four nursing home residents will have received a prescription for an antiviral drug to treat coronavirus infection by the end of 2022. found in research. The data shows that by May 2023, this rate has risen to nearly one-third of nursing home residents, said Brian McGarry, an assistant professor of medicine at the University of Rochester, one of the study's authors.
Federal officials have since stopped asking about paxrovid use in weekly nursing home coronavirus surveys.
“I think things are getting better little by little,” Dr. McGarry said. “But at the same time, facilities are now dealing with RSV, as well as influenza, in addition to COVID-19.”
