Covid-19 antiviral to be made available to most older patients

An antiviral pill that can prevent people becoming seriously ill with Covid-19 is to be made more widely available to older patients, after months of low take-up.

Just 647 doses of Paxlovid have been prescribed for use in the community so far, according to the latest figures from the HSE.

In contrast, millions of patients in the US and the UK – including, last month, US president Joe Biden – have received the treatment, which is manufactured in Ireland by Pfizer.

Up to now, use of the drug has been confined to unvaccinated or immunocompromised patients at the highest risk of serious illness if they contract Covid-19. In addition, infection had to be confirmed by a PCR test before a person could receive a prescription for Paxlovid, which must be taken within five days of the appearance of symptoms.

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Under new HSE guidance, the drug can be prescribed for most older people, even if they are vaccinated. In addition, a positive antigen test will now suffice for prescription.

Under the change, the pill is being made available to vaccinated people aged over 75, and vaccinated over-65s with additional risks. These include obesity, diabetes, high blood pressure, heart and lung disease and other serious risk factors.

The HSE guidance document says the strongest evidence for treating Covid-19 is for using steroids and clot prevention, and the use of the tocilizumab in rapidly deteriorating patients.

The evidence base for new preventive products such as Paxlovid is described as “limited”, as trials were carried out in unvaccinated populations and prior to the spread of new variants of concern.

“Given the paucity of strong evidence, some clinicians may wish not to prescribe these novel therapies and this is a valid clinical management strategy,” it advises.

“Vaccines reduce harm caused by Covid-19 infection and are superior to the treatments listed in this document. Treatments should not be considered as an alternative to vaccination.”

Paxlovid, which has some side effects, has been shown in trials involving unvaccinated people to reduce the risk of hospitalisation and death from Covid-19 by 89 per cent.

However, it has not been shown to be effective against mild illness. Some patients, including Mr Biden, have suffered “rebound Covid” after taking the drug; after testing negative they test positive again and experience a second bout of illness. However, this is usually mild.

Paxlovid is manufactured by Pfizer at plants in Ringaskiddy and Newbridge.

Use of another new treatment, Sotrovimab, is no longer recommended by the HSE as it is less effective against the Omicron variants currently in circulation.

Another new treatment, Evusheld, is still in the process of being assessed. The National Centre for Pharmacoeconomics, which assesses drugs for cost-effectiveness, says consultations with the manufacturer are scheduled.

Evusheld, made by AstraZeneca, is available in France and the US but not in the UK.

Michael Rynne, of blood cancer group CLL Ireland, described Evusheld as the equivalent to the vaccine for immunocompromised people and said “our Government deny access to Irish patients, leaving them at severe risk to Covid”.