COVID drug Paxlovid was hailed as a game-changer. What happened? – Nature.com

by | Jan 3, 2023 | COVID-19

Tablets of Paxlovid, which reduces risk of severe COVID-19, are inspected by a laboratory technician.Credit: Thomas Hansmann/AP/Shutterstock

When clinical trial data for the antiviral drug Paxlovid emerged in late 2021, physicians hailed its astonishing efficacy — a reduction of nearly 90% in the risk of severe COVID-19. But more than a year later, COVID-19 remains a leading cause of death in many countries, and not only in low-income nations where the drug is in short supply. In the United States, for example, hundreds of people still die from COVID-19 each day.Researchers say that the drug’s rollout has been hampered by worries about ‘rebound’ (the mysterious return of symptoms or detectable virus days after a person starts to feel better) and side effects — as well as by declining concern about the risk of COVID-19. Inadequate funding for distribution, the drug’s high price tag and the need for it be taken soon after infection have also slowed its uptake. As a result, physicians have prescribed the drug in only about 0.5% of new COVID-19 cases in the United Kingdom, and in about 13% in the United States, according to a report by the health-analytics firm Airfinity, based in London, UK. Even doctors have reported serious difficulties in helping their family members to obtain Paxlovid1.Sentiment against the drug has persisted even as regulators globally have rescinded authorizations for monoclonal antibodies against COVID-19, leaving Paxlovid as one of the only tools to prevent death in high-risk individuals, says Davey Smith, an infectious-disease physician at the University of California, San Diego. “It’s a game-changer drug that has good efficacy, even in the setting of Omicron,” says Smith. “But rebound has been tagged as a reason not to take the drug, which is a shame.”Premium protectionPaxlovid is a combination of the oral antiviral drugs nirmatrelvir and ritonavir. It reduced the risk of hospitalization or death by 89% in high-risk individuals who took the drug within three days of experiencing symptoms, according to a clinical trial2 sponsored by pharmaceutical company Pfizer, which produces the drug and is based in New York City.US regulators first authorized Paxlovid in December 2021, and have since loosened restrictions on who can prescribe it in an effort to make it more broadly available. But health officials lament that the dr …

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