US doctors reconsider Pfizer’s Paxlovid for low-risk COVID patients

May 28 (Reuters) – Use of Pfizer Inc’s (PFE.N) COVID-19 antiviral Paxlovid soared this week, but some doctors are reconsidering pills for lower-risk patients after a public health agency in USA a course of the drug, and then they must isolate a second time.

More quarantine time is “not a crowd pleaser,” Dr. Sandra Kemmerly, an infectious disease specialist at Ochsner Health in New Orleans, told Reuters. “For those people who are really not at risk … I would recommend that they not take it.”

Use of Pfizer’s Paxlovid, licensed to treat newly infected at-risk people to prevent serious illness, has soared as infections rise. More than 162,000 courses were administered last week, compared with an average of 33,000 a week since the drug was launched late last year, according to government data. Biden administration officials have pushed for widespread use of Paxlovid, which the government purchased and provides for free.

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But increased use has also come with more reports of people saying their symptoms eased on Paxlovid only to return a few days after finishing a five-day regimen of the pills.

On Tuesday, the Centers for Disease Control and Prevention, citing case reports and concerns that relapsing patients could spread the virus, issued its warning that Paxlovid users should isolate for another five days if symptoms rebound. . read more

“I shy away from giving it to people who are very low risk and not very sick, particularly people who are vaccinated and boosted,” said Dr. Bruce Farber, chief of public health and epidemiology at Northwell Health. He said that he still recommends Paxlovid for people who have significant health problems or who are over the age of 75.

Pfizer, in an email, said it is monitoring the data but believes the return of detectable viruses is rare and not associated solely with its drug. “We have not seen any resistance emerge to date in patients treated with Paxlovid,” a spokesman said.

Paxlovid’s emergency authorization stipulates that it should be used only for newly infected people with risk factors, but doctors said many others have sought a prescription.

“We get a lot of requests, maybe someone is traveling and wants to take it just in case,” said Dr. Tara Vijayan, an infectious disease specialist at UCLA Health in Los Angeles. “We’re not offering it just in case.”

The CDC also said it’s not clear if the cases of rebound symptoms have anything to do with Paxlovid or are simply part of the natural pathway of COVID-19. The agency did not note any specific concerns about health effects.

“COVID has historically had this kind of stutter course — people will feel better one day and then feel worse the next day — but I can say we haven’t seen these rebound symptoms with other COVID treatments,” Vijayan said, referring to to therapies such as monoclonal antibodies.

“Patients who get a rebound, it’s usually very mild,” said Dr. Earl Strum, medical director of employee health at USC Keck Medicine in Los Angeles.

Some question how much Paxlovid is helping given the large number of people vaccinated or previously infected with COVID-19. The drug was authorized in December after a study in unvaccinated high-risk COVID patients with conditions such as diabetes showed an 88% reduction in hospitalizations or deaths.

At the time, the Delta variant was prevalent, but has since been displaced by the more transmittable Omicron.

“There’s a lot more baseline immunity. There are still a lot of infections, but they’re not as severe,” Northwell’s Farber said.

He estimated the Paxlovid-related COVID rebound rate at around 10%, higher than the 3-4% rate cited by Pfizer in its trials of the drug.

Jason Gallagher, an infectious disease expert at Temple University School of Pharmacy, said the rebounds don’t detract from the drug’s usefulness. “It keeps you from going to the hospital … if you get symptomatic after you stop taking it, that sucks, but the drug was a success overall,” he said.

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Reporting by Deena Beasley in Los Angeles Editing by Caroline Humer and Matthew Lewis

Our standards: the Thomson Reuters Trust Principles.

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