Health
Do young and healthy patients need to take Paxrovid?
The development of an oral antiviral drug that can reduce COVID-19 hospitalization and mortality in unvaccinated high-risk individuals is nothing more than a game change, a clinician like me sought. did.This milestone is from the FDA Granting an emergency use permission (EUA) In December 2021 at Pfizer’s Nirmatrelville / Ritnaville (Pax Rovid).
The active ingredient in the combination is nilmatrelvir, a molecule that blocks the protease enzyme of SARS-CoV-2. Ritonavir, which happens to be a protease inhibitor, is used in this combination not because of its antiviral effect, but because of the pharmacological boost of nilmatrelvir levels in the body. The drug targets the virus and its “life cycle”, so the sooner you take it, the greater the impact. Therefore, this drug is indicated within 5 days after the onset of symptoms.
However, in some anecdotal reports of young and healthy people taking Nirmatrelvir / Ritonavir, the immediate problem is: medical professionals prescribe antivirals to these patients Should it be?
The main purpose of developing drugs like Nilmatrelvir / ritonavir was to reduce the likelihood that an individual would develop severe COVID-19.Therefore, the merit is Most prominent and obvious In people who are at a fairly high risk of severe illness, Low risk group.. Indeed, given that vaccination significantly reduces the risk of serious illness, the impact on vaccinated individuals has been controversial. However, recent studies have shown that Profit exists Elderly high-risk vaccinated person.
This drug is indicated to reduce the risk of serious illness and is intended only for people who are at risk of serious illness and have symptoms. this is, united states of america.. For example, the risk of serious illness in a healthy 29-year-old is very low, and Nirmatrelvir / ritonavir does not significantly reduce the incidence of what is already very rare.So, of course, recent studies have shown that antivirals Did not show great profit For low-risk individuals.
In my practice, I do not prescribe Nirmatrelvir / Ritonavir for people at low risk of severe illness, but do not hesitate to prescribe it for people at high risk or over the age of 60. Benefit from fighting the virus without the help of antiviral drugs; rather, because the drug has not been shown to be of value in this population. Low-risk people, no matter how persistent they are on antiviral medication, can benefit from medications aimed at reducing the risk of death or hospitalization if the risk of death or hospitalization is negligible. It is important to explain that there is no such thing. .. It is usually sufficient to discuss how the data currently only support the use of drugs at high risk rather than low risk. There are no major side effects to worry about except for changes in taste and diarrhea (drug-drug interactions are usually not a problem in healthy populations who are not prescribed other drugs), but drugs are simply beneficial outside. Not shown for high risk groups.
In the future, data on nirmatorelvir / ritonavir or other antivirals may emerge. Although these antivirals help reduce the duration of symptoms, infectiousness, and / or risk of long-term symptoms, there are no data on filmatrelvir / ritonavir yet. Studies in which the results target these secondary benefits are of great interest and will be a major step forward for tame the virus and make COVID-19 more manageable.
Ameshua Darha, MD, A senior scholar at the Johns Hopkins Center for Health Security, he practices infectious diseases, life-saving physicians, and emergency physicians in Pittsburgh. He has no relevant disclosures.
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