WHO Strongly Recommends Pfizer's COVID-19 Antiviral Drug

Pfizer's oral antiviral drug (a combination of nirmatrelvir and ritonavir tablets) is strongly recommended for patients with non-severe COVID-19 who are at the highest risk of hospitalization, such as unvaccinated, older, or immunosuppressed patients, with lack of vaccination as an additional risk factor to consider, says a WHO Guideline Development Group of international experts in the BMJ today.

However, they recommend against its use in patients at lower risk, as the benefits are trivial. And they make no recommendation for patients with severe or critical covid-19, as there are currently no trial data on nirmatrelvir/ritonavir for this group.

‘Pfizer�s oral antiviral COVID-19 drug is easier to administer than intravenous options such as remdesivir and antibody treatments in non-severe COVID-19 patients.’

Their recommendation is based on new data from two randomized controlled trials involving 3,100 patients.

In these trials, moderate certainty evidence showed that nirmatrelvir/ritonavir reduced hospital admission (84 fewer admissions per 1,000 patients), low certainty evidence suggested no important difference in mortality, and high certainty evidence suggested little or no risk of adverse effects leading to drug discontinuation.

In the same guideline update, WHO also makes a conditional (weak) recommendation to use the antiviral drug remdesivir for patients with non-severe covid-19 at the highest risk of hospitalization.

This is based on new data from five randomized controlled trials involving 2,700 patients and replaces a previous recommendation against treatment with remdesivir in all patients with covid-19 regardless of disease severity.

Antiviral drugs should be administered as early as possible in the course of the disease and acknowledged some cost and resource implications that may make access to low and middle-income countries challenging, noting, also, that the access to these drugs is tied to the access to SARS-CoV-2 diagnostic tests, especially for those targeting the early phase of the disease.

There also remains uncertainty regarding the risk of the emergence of resistance. Living guidelines allow researchers to update previously vetted and peer-reviewed evidence summaries as new information become available.

This guidance adds to previous conditional recommendations for the use of molnupiravir for high-risk patients with non-severe covid-19 and the use of sotrovimab or casirivimab-imdevimab (monoclonal antibody treatments) in selected patients; and against the use of convalescent plasma, ivermectin and hydroxychloroquine in patients with covid-19 regardless of disease severity.

� For patients with severe covid-19, WHO strongly recommends corticosteroids, with the addition of IL-6 receptor blockers or baricitinib.



Source: Medindia