WHO recommends Paxlovid for patients with non-severe COVID-19

WHO has announced that it strongly recommends administering Pfizer’s Paxlovid to patients with non-severe COVID-19 who are at highest risk for hospitalization.

The agency also issued a conditional recommendation for the use of remdesivir, marketed in the U.S. as Veklury (Gilead Sciences), for the same patient population.

“In patients with non-severe illness at highest risk of hospitalization, the recommendations for treatment with [Paxlovid (nirmatrelvir/ritonavir)] and remdesivir reflect what the Guideline Development Group considered to be important reductions in admission to hospital (moderate certainty) with little or no impact on mortality, mechanical ventilation, time to symptom resolution (low to very low certainty) and adverse effects leading to drug discontinuation (high certainty for nirmatrelvir/ritonavir, moderate certainty for remdesivir),” Arnav Agarwal, MD, a clinical fellow of general internal medicine at McMaster University in Ontario, Canada, and co-authors of the guidelines wrote.

The recommendation is based on new data from several randomized controlled trials published in the BMJ.

The two randomized controlled trials supporting the use of nirmatrelvir/ritonavir among this patient population involved 3,100 patients. Researchers reported 84 fewer hospital admissions per 1,000 patients who received nirmatrelvir/ritonavir within 5 days. Physicians should administer the antiviral combination as early as possible to eligible patients, Agarwal and colleagues wrote.

The five randomized controlled trials supporting the use of remdesivir involved 2,700 patients. Researchers reported 73 fewer hospital admissions per 1,000 patients with the antiviral. Optimal timing, duration and dosing of remdesivir remain unclear, according to the guideline authors.

The Guideline Development Group acknowledged some cost and resource implications, which may hinder rapid access to the antivirals in low- and middle-income countries, and that access to these drugs is tied to access to SARS-CoV-2 diagnostic tests, according to a BMJ press release.

This is the 10th version of WHO’s living guidelines on drugs for COVID-19. Amid the new recommendations, WHO called on Pfizer to widen the geographic distribution of nirmatrelvir/ritonavir and provide transparency with the company’s pricing and dealings.

References:

Agarwal A, et al. BMJ. 2022;doi:10.1136/bmj.m3379.

WHO recommends highly successful COVID-19 therapy and calls for wide geographical distribution and transparency from originator. https://www.who.int/news/item/22-04-2022-who-recommends-highly-successful-covid-19-therapy-and-calls-for-wide-geographical-distribution-and-transparency-from-originator. Published April 21, 2022. Accessed April 21, 2022.

WHO strongly recommends antiviral drug for patients with non-severe COVID-19. https://www.bmj.com/company/newsroom/who-recommends-antiviral-drug-for-patients-with-non-severe-covid-19-at-highest-risk-of-hospital-admission/. Published April 21, 2022. Accessed April 21, 2022.