What is Paxlovid Pill that WHO 'strongly recommends' against COVID-19?

The World Health Organization on April 22, 2022 "strongly recommended" Pfizer's Paxlovid Covid antiviral pill for mild COVID cases with high risk of hospitalisation. The Covid antiviral pill prevents hospitalisation more than the "available alternatives and has fewer concerns with respect to harm that molnupiravir.

Paxlovid pill is Pfizer's combination of nirmatrelvir and ritonavir and is easier to administer in comparison to intravenous remdesivir and antibodies. The pill is reportedly a better choice of treatment for the unvaccinated and elderly and immunocompromised people with COVID-19,as per WHO experts.

WHO has recommended Paxlovid pill for COVID-19 treatment over remdesivir and even over Merck's molnupiravir pill and monoclonal antibodies in the BMJ medical journal. The health organisation has also made a "conditional (weak) recommendation" of US biotech firm Gilead's antiviral drug remdesivir for patients with mild covid infection. The body had previously recommended against the drug.

What is Paxlovid pill?

Paxlovid is an oral covid antiviral pill that can be taken at home by high-risk covid patients with mild infection, preventing the need for hospitalisation. The pill is a combination of nirmatrelvir and ritonavir drugs. While nirmatrelvir inhibits a SARS-CoV-2 protein to stop the virus from replicating, ritonavir slows down nirmatrelvir’s breakdown to help it remain in the body for a longer period at higher concentrations. 

Why has WHO strongly recommended Paxlovid pill for COVID patients?

WHO has strongly recommended the Paxlovid pill for patients with milder forms of the disease who were still at a high risk of hospitalisation. The new recommendation is based on findings of two trials involving 3100 patients that showed that Paxlovid reduced the risk of hospital admission.The trials suggest no important difference in mortality and "little or no risk of adverse effects leading to drug discontinuation".

Who can be administered the Paxloid pill?

WHO has recommended the administration of the pill to people over the age of 18 years.

Who have been recommended against taking the Covid antiviral pill?

WHO has not recommended the Covid antiviral pill for pregnant or breast-feeding women. The pill has also not been advised for people with low risk of complications from the disease as the benefit would not be much.

WHO has also not suggested the pill for patients with severe forms of the disease and declined to give an opinion on the same due to lack of sufficient data to prove its efficiency in such cases. 

Paxlovid Pill- 5 things to know

1. Paxlovid dosage- The Paxlovid pill is administered as three tablets, two tablets of nirmatrelvir and one tablet of ritonavir. These tablets have to be taken together orally twice daily for five days. In total, the patients will have to take 30 tablets over 5 days.

2. Paxlovid course-The covid antiviral pill is not authorized for use for longer than five consecutive days. It is available by prescription only.

3. Effect-The Paxlovid covid antiviral pill was found to reduce the risk of hospitalization or death by 89% compared to placebo in non-hospitalized high-risk adults with COVID-19.

4. Paxlovid Price- WHO has urged Pfizer to make Paxlovid pill's pricing and deals more transparent. Currently, a full course of Paxlovid costs $530 in the United States. Pfizer has agreed to allow some generic drugmakers around the world to make cheaper versions of Paxlovid under a UN-backed scheme and make it available faster at affordable prices.

5 Paxloid pill significance- The covid antiviral pills like the Paxloid pill are being seen as a potential step towards ending the COVID-19 pandemic. These pills can be taken at home upon prescription from the doctor. However, there are also concerns over whether the virus could build resistence to these treatments. 

Limitations of Paxloid COVID antiviral pill

The Paxloid COVID-19 antiviral pill can only be administered while the disease is at its early stages. This means that the pill has to be administered as soon as the patients test positive. Patients must start the course within 5 days of the onset of first symptoms. The entire course will last 5 days. This would prove to be a challenge for the low- and middle-income countries.

On the other hand, Remdesivir can be taken within seven days of symptoms setting in, but it is administered intravenously over three days.

Background

Pfizer CEO Albert Bourla has predicted a bright future for the COVID antiviral treatments saying that people will soon grow tired of getting booster doses. 

This comes at a time when WHO warned that it was "extremely concerned" that the inequality in access seen with Covid vaccines would again leave low- and middle-income countries "pushed to the end of the queue".