U.S. doctors reconsider Pfizer’s Paxlovid for lower-risk COVID patients

By Deena Beasley

(Reuters) – Use of Pfizer Inc’s COVID-19 antiviral Paxlovid spiked this week, however some docs are reconsidering the tablets for lower-risk sufferers after a U.S. public well being company warned that signs can recur after folks full a course of the drug, and that they need to then isolate a second time.

Extra quarantine time “just isn’t a crowd-pleaser,” Dr. Sandra Kemmerly, an infectious illness specialist at Ochsner Well being in New Orleans, informed Reuters. “For these individuals who actually aren’t in danger … I might suggest that they not take it.”

Use of Pfizer’s Paxlovid, approved to deal with newly contaminated, at-risk folks with a purpose to stop extreme sickness, has soared as infections have risen. Greater than 162,000 programs had been disbursed final week – in contrast with a mean of 33,000 per week for the reason that drug was launched late final yr, in response to authorities information. Biden administration officers have pushed for large use of Paxlovid, which the federal government bought and gives free.

However increased use has additionally include extra experiences from individuals who say their signs eased with Paxlovid solely to return a number of days after ending a five-day routine of the tablets.

On Tuesday, the Facilities for Illness Management and Prevention, citing case experiences and issues that relapsed sufferers might unfold the virus, issued its advisory that Paxlovid customers ought to isolate for a second 5 days if signs rebound.

“I’m shying away from giving it to people who find themselves very low- danger, and usually are not terribly ailing, significantly people who find themselves vaccinated and boosted,” stated Dr. Bruce Farber, chief of public well being and epidemiology for Northwell Well being. He stated he’s nonetheless recommending Paxlovid for individuals who have vital well being circumstances or are over age 75.

Pfizer, in an e mail, stated it’s monitoring the info, however believes the return of detectable virus is unusual and never uniquely related to its drug. “We’ve not seen any resistance emerge to this point in sufferers handled with Paxlovid,” a spokesperson stated.

Paxlovid’s emergency authorization stipulates that it must be used just for newly contaminated folks with danger components, however docs stated many others have sought out a prescription.

“We get plenty of requests – perhaps someone is touring they usually need to take it simply in case,” stated Dr. Tara Vijayan, infectious illness specialist at UCLA Well being in Los Angeles. “We aren’t providing it as a just-in-case.”

The CDC additionally stated it’s unclear whether or not instances of rebound signs have something to do with Paxlovid, or are merely a part of the pure trajectory of COVID-19. The company didn’t flag any particular issues about well being results.

“COVID traditionally has had this kind of stuttering course – folks will really feel higher at some point after which really feel worse the following day, however I can say we’ve not seen these rebound signs with different COVID remedies,” stated Vijayan, referring to therapies similar to monoclonal antibodies.

“The sufferers that do get a rebound, it is often very gentle,” stated Dr. Earl Strum, medical director of worker well being at Keck Medication of USC in Los Angeles.

Some query how a lot Paxlovid helps given the excessive variety of folks vaccinated or beforehand contaminated with COVID-19. The drug was approved in December after a examine in unvaccinated, high-risk COVID sufferers with circumstances like diabetes confirmed an 88% discount in hospitalization or loss of life.

On the time, the Delta variant was prevalent, nevertheless it has since been displaced by the extra transmissible Omicron.

“There’s a lot extra baseline immunity round. There’s nonetheless plenty of infections, however they don’t seem to be almost as extreme,” Northwell’s Farber stated.

He estimated the speed of Paxlovid-related COVID rebounds at round 10% – increased than the 3-4% charge cited by Pfizer in its trials of the drug.

Jason Gallagher, an infectious ailments skilled at Temple College’s Faculty of Pharmacy, stated the rebounds don’t detract from the drug’s utility. “It prevents you from going to the hospital … when you develop into symptomatic after you cease taking it, that stinks, however the general drug was successful,” he stated.

(Reporting by Deena Beasley in Los Angeles; Enhancing by Caroline Humer and Matthew Lewis)