Health
High-risk COVID-19 patients are now available with two antiviral prescription drugs, but some are still deficient
For Australians at high risk of developing severe COVID-19, access to potentially life-saving treatments has recently become easier, but experts say they still miss it.
May 1, COVID-19 antiviral drug Paxlovid — the most effective oral treatment ever — It is listed in the Pharmaceutical Benefits Scheme (PBS)That is, it can now be prescribed by a general practitioner or nurse and dispensed at a local pharmacy.
This is the second antiviral drug listed on PBS for people at high risk of severe COVID-19. Addition of molnupiravir (Also known as “Lagevrio”) It dates back to March.
Both drugs are not a substitute for vaccination, but they help avoid the worst effects of the virus and reduce the risk of hospitalization, said Bruce Willett, Vice President of the Royal Australian General Practitioner.
“They don’t completely cure COVID-19, but they reduce its severity and play a very important role in keeping people safe,” he said.
With the addition of oral antiviral treatment to PBS, many high-risk Australians are now able to receive COVID-19 treatment at home rather than in the hospital.
“Previously, patients at high risk of developing severe illness were sent to the emergency department for intravenous administration,” said Dr. Willett.
“So this really helps deliver these medicines to people, and helps them deliver them quickly.”
Despite the increased availability, Dr. Willett said many high-risk Australians are unaware that COVID-19 antivirals may be accessible through the GP.
“Therefore, raising awareness and increasing the ability to deliver these medicines to people when needed is truly life-saving.”
Who is eligible for prescription antiviral drugs?
Adults with mild to moderate COVID-19 confirmed by PCR or rapid antigen test can be considered for oral antiviral treatment if:
- 65 years and older, two other risk factors for severe illness
- 75+, another risk factor
- Identifying Aboriginal or Torres Strait Islanders over the age of 50, with two other risk factors
- Over 18 years of age, moderate to severe immunodeficiency
To be eligible for treatment, the patient must have at least one sign or symptom of COVID-19 (fever, cough, headache, etc.) and be able to begin treatment within 5 days of the onset of symptoms.
“They are [medications] It’s intended for people who are at risk of severe symptoms and are ill, but don’t need hospitalization or oxygenation, “Dr. Willett said.
Risk Factors for Severe Illness — Listed here — Includes neurological conditions such as unvaccinated, home care, respiratory problems, heart failure, obesity, diabetes, stroke and dementia.
The list of immunodeficiency states has been expanded to include conditions such as Down’s syndrome, cerebral palsy, and severe intellectual and physical disability.
Not everyone is eligible for antiviral treatment, but if you think you’re at high risk, your doctor is “certainly worth asking,” says Dr. Willett.
They examine your individual situation, medical history, age, and vaccination status (including time since vaccination).
Government COVID-19 Symptom Checker Or phone National coronavirus helplineBoth will advise you on your eligibility, said Chris Moy, Vice President of the Australian Medical Association.
“They guide you through algorithms to resolve whether you should go to the hospital as well as whether you are at risk. [and therefore eligible for antivirals]”Dr. Moi said.
How do I access antiviral drugs?
Like all antiviral drugs, paxlobide and molnupiravir work best in the early stages of infection. Therefore, it should be taken within 5 days of the onset of symptoms.
Due to the short time frame, it is important to have your COVID-19 tested as soon as possible and contact your GP if you get a positive result.
“In the past, if people were unaware or aware of the drug, there was a problem because they hadn’t gone through the process of being tested and seeing a doctor in those five days,” Dr. Moi said.
“The hit rate is pretty low, but it’s improved and I hope it’s even better.”
GPs are often busy or booked, so be sure to let us know that you are seeking COVID-19 antiviral treatment and that you are time sensitive.
If you don’t have a regular general practitioner or can’t make an appointment for telemedicine, Dr. Moi recommends calling National coronavirus helpline..
“They will give you some other options,” he said.
If you are eligible for treatment, we recommend that you arrange for the medicine to be delivered to your home at the pharmacy or have someone collect the medicine for you.
“There are still some issues across the country regarding availability in pharmacies,” Dr. Willett said.
“But as more people notice … I see pharmacies actually increasing their supply.”
What if I’m not technically qualified?
GPs are discouraging prescribing COVID-19 antivirals to people who are not covered by PBS due to limited supply.
“We are being asked to limit these medications for those who are eligible to ensure that those at risk of developing severe illness can take them,” Dr. Willett said.
“It is very difficult for the GP to bend the rules on this due to lack of supply.”
How effective is antiviral treatment?
Clinical trials have shown that both oral treatments reduce the risk of hospitalization and death. However, while Paxlovid seems to be more effective, it is not always suitable for prescribing (see below for details).
Developed by Pfizer, the drug is made up of two different antiviral drugs, pirrmatrelvir and ritonavir.
Nirmatrelvir is a COVID-19-specific drug designed to interfere with the ability of the virus to grow. Ritonavir was once used as a treatment for HIV / AIDS, but because it slows the body’s metabolism, the drug remains active in the body longer and at higher concentrations.
A Paxlovid Phase 3 clinical trial We found that if unvaccinated COVID-19 patients were treated within 5 days of the onset of symptoms, the risk of hospitalization and death was reduced by 89%.
“The problem is that you can’t take Paxrovid if you have serious liver dysfunction or kidney disease, so we exclude many older patients,” said Dr. Moi.
“Also, certain people cannot take it because it has a major interaction with commonly used medicines such as cholesterol tablets.”
If Paxlovid is not appropriate, patients may be prescribed molnupiravir or sotrovimab (sold as “Xevudy”) — monoclonal antibody therapy given by intravenous infusion.
“When Molnupiravir first appeared, its initial efficacy was 50%, but then dropped to about 30-35%,” said Dr. Moy.
“There are some new data coming out that may change that — some new evidence that it may be more effective than the first number of them.”
Sotrovimab was initially known to reduce the risk of hospitalization and death by 79%, New preliminary data The drug may be less effective against the Omicron BA.2 variant..
Who is the antiviral treatment no Recommended for?
As Dr. Moi pointed out, Paxrovid is not recommended for people with severe liver or kidney damage.
It also has A long list of medicines that cannot be taken togetherAmong other things, it includes some common medicines used to treat high blood pressure, arrhythmias, arthritis, psychosis, and cancer.
Both Paxlovid and molnupiravir are not recommended during pregnancy or lactation. People who are “potential for childbirth” are advised to use contraception during treatment (and for the next few days).
Pre-identify vulnerable people
High vaccination rates mean that the majority of Australians are well protected from severe COVID-19, but Dr. Moy has significantly weakened immunity and poorly vaccinated people. Many people, including those, are still at risk.
“COVID-19 is not a cold. It is a serious polyphyletic disorder, and especially high-risk people can still be hospitalized and die,” he said.
“We use antivirals not only to prevent people from dying, but also to prevent people from getting sick and going to the hospital, potentially becoming a big long COVID.”
Ideally, Dr. Moy states that health authorities will soon be able to identify all high-risk individuals and be notified in advance.
“Then you can tell them that if they get COVID-19, they need to be treated and promote testing and so on.”
He continued that vaccination “always beats antivirals,” but emphasized that drug treatment was an important part of Australia’s COVID-19 weapons.
“Prevention is better than cure, so the main focus should be vaccination,” he said, noting Australia’s delayed booster deployment.
“But this is a great second stop.”
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