Paxlovid, Pfizer’s Covid-19 antiviral pill, has been “strongly recommended” by the World Health Organization (WHO) for patients with milder forms of the disease who are still at high risk of hospitalisation. The WHO has recommended Paxlovid over Remdesivir, as well as over Merck’s Molnupiravir pill and monoclonal antibodies.
WHO experts have said that Pfizer’s oral treatment prevents hospitalisation more than the “available alternatives, has fewer concerns with respect to harms than Molnupiravir, and is easier to administer than intravenous Remdesivir and antibodies”.
Here’s all you need to know about the pill touted as the wonder drug against Covid-19:
What is Paxlovid?
Paxlovid is a combination of two generic medications nirmatrelvir and ritonavir, and has emerged as the “superior choice” of treatment for unvaccinated, elderly or immunocompromised people with Covid.
Two trials involving almost 3,100 patients showed that Paxlovid reduced the risk of hospital admission by 85%. The trials also “suggested no important difference in mortality” and “little or no risk of adverse effects leading to drug discontinuation”.
Who Can Take Paxlovid?
The pill is administered as three tablets (two tablets of nirmatrelvir and one of ritonavir) taken twice a day for five days for a regimen of 30 tablets.
The WHO recommendation applies to people over the age of 18, but not to pregnant or breastfeeding women. It also does not apply to patients with a low risk of complications from the disease, because the benefit would be minimal.
The WHO’s experts have also declined to give an opinion for patients with severe forms of the disease, due to a lack of data.
How Does Paxlovid Compare to Molnupiravir
Both pills have claims to being path-breaking medications in their own right. Merck says Molnupiravir is the “first oral antiviral medicine authorised for the treatment of mild-to-moderate Covid-19″ while Pfizer states that Paxlovid is the “first oral antiviral of its kind” based on the strategy it deploys to counter the disease.
During trials, the Pfizer drug reduced the risk of hospitalisation or death by 89% in non-hospitalised high-risk adults as compared to the placebo group. The company said that the overall study showed that over a period of 28 days, no deaths were reported in patients who received Paxlovid as compared to 10 deaths in patients who received a placebo.
The Molnupiravir trial showed the pill reduced the risk of hospitalisation or death by about 50% as compared to the placebo group. The company said that through Day 29, no deaths were reported in patients who received Molnupiravir, as compared to eight deaths in patients who received placebo.
What Are Paxlovid Limitations?
Stressing the limitations of antiviral treatments, WHO experts said, “The medicine can only be administered while the disease is at its early stages.” This means the patients must quickly test positive and be prescribed the pill by a doctor, all of which can pose obstacles for low- and middle-income countries, the WHO said.
Patients must start taking their Paxlovid pills within five days of the onset of symptoms; the course then lasts five days. Remdesivir can be taken within seven days of symptoms setting in, but it is administered intravenously over three days.
How Much Does Paxlovid Cost?
A full course of Paxlovid reportedly costs $530 in the United States. Another source, unconfirmed by WHO, gave the price of $250 in an upper-middle income country. Remdesivir meanwhile costs $520, but generic versions made by companies in India sell for $53-$64.
Skewed Supply
Coming under fire for prioritising wealthy countries with its vaccine, Pfizer has agreed to allow some generic drugmakers around the world to make cheaper versions of Paxlovid under a UN-backed scheme.
But on Friday the WHO “strongly recommended” that Pfizer let more generic manufacturers produce the drug and “make it available faster at affordable prices”.
According to a Reuters report, Pfizer has said it initiated talks with 100 governments for Paxlovid, and agreements are in place with 26 countries.
“Governments are trying to define their demand in light of the evolving landscape with Omicron, future variants and other antiviral options,” Pfizer said. “This is a rapidly evolving situation and changes hour by hour.”
The Paxlovid rollout has also been slow in Asia.
A report in Moneycontrol.com quoted a source in the Union Health Ministry as saying that pricing negotiations and discussions around local clinical trials had delayed Paxlovid’s launch in India.
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