Evolving COVID-19 variants limit effectiveness of current therapies
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PHILADELPHIA — Outpatient therapies for COVID-19 are largely being limited by evolving variants’ ability to evade effectiveness, and remaining therapies require careful management, according to a speaker at ACR Convergence 2022.
“Current therapy is being limited by evolving variants,” Rachael Perritt, PharmD, BCPS, of the Hospital of the University of Pennsylvania, in Philadelphia, told attendees. “We still do have pre-exposure prophylaxis, with tixagevimab/cilgavimab [Evusheld, AstraZeneca], however, treatment relies heavily on antiviral agents with good in vitro susceptibility.”
The management of COVID-19 in patients with autoimmune and rheumatic diseases is important due to the increased risks this patient population faces from routine infection, Perritt said.
“As we all know, our patients in rheumatology are at increased risk of, No. 1, developing COVID, as well as having severe risk for death and disability from COVID,” Perritt said, adding that it is important for rheumatologists to understand the available therapies as well as the potential contraindications among them.
“I am not going to go too deeply into vaccination, but obviously, this is the workhorse of how we protect our patients from COVID-19,” Perritt said. “Patients should be vaccinated as far as the recommendations that currently exist can take them, and their family members should be vaccinated as well to kind of cocoon them from a COVID-189 infection.”
In the realm of antivirals, nirmatrelvir plus ritonavir (Paxlovid, Pfizer) represents first-line therapy, but is not without drawbacks.
“We do know that viral rebound is seen in observational studies,” Perritt said. “That is not to say that we should not use it, it is just something that we need to look out for and patients should be aware of.”
Longer courses of the therapy have not yet been approved. When considering using nirmatrelvir plus ritonavir in patients with rheumatic diseases, Perritt recommended using the University of Liverpool Drug Interaction Checker to help manage expected drug interactions.
Molnupiravir (Lagevrio, Merck) is another potential antiviral for patients with COVID-19, but varying reported effectiveness and adverse events make it a more limited option, according to Perritt.
“Really, it is kind of last-line in the event that we don’t have any other options available,” he said.
Finally, patients who are not eligible to receive antiviral therapy may be considered for bebtelovimab (Eli Lilly & Co.), a monoclonal antibody therapy. There is, however, limited clinical data available for bebtelovimab, and usage should be matched with regional variants, Perritt said.
“The big thing about this is that it needs to be in an area where the regional variants are susceptible,” he added.
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Perritt R. Latest COVID and rheumatic disease therapies: What you need to know. Presented at: ACR Convergence 2022; Nov. 11-15, 2021; Philadelphia (hybrid meeting).
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