As Covid surges again, killing about 1,500 Americans every week, medical researchers are trying to understand why so few people are taking Paxlovid, an incredibly effective drug at preventing serious illness and death from the disease.
A study of a million high-risk people with Covid found that only about 15% of those eligible for the drug took it. If instead half of eligible patients in the United States had received Paxlovid during the research period, 48,000 deaths could have been avoided, according to the study authors. the studyconducted by the National Institutes of Health, concluded.
It’s not because people don’t know about this drug – most do – but the reluctance seems to come from doctors worried about interactions with other drugs and people wary of a possible case of it. rebound or a metallic aftertaste.
Regional differences offer a clue, with adoption highest in Democratic strongholds in the Northeast and Pacific Northwest regions of the United States and lowest in deep red areas, including Florida and Indiana . Yet no careful study has clarified why so few people used the drug, which reduced the risk of death by 73% for high-risk patients in the NIH study.
“I don’t know why there is such variability and why adoption isn’t higher across the board,” said Dr. Josh Fessel, senior clinical advisor to the National Institutes of Health team that studied the use of the drug. “If you can take Paxlovid and you take Paxlovid within the recommended time frame, the risk of death or hospitalization is significantly reduced. It’s a big problem.
Covid deaths have increased since September, between 1,200 and 1,300 deaths per week, reaching around 1,500 per week in December. Researchers say they will likely continue to rise unless more people receive updated Covid vaccines and antiviral treatments.
Dr. Fessel said that during the NIH study of one million people, about 10% of high-risk patients eligible for Paxlovid took it, although that rate increased to about 15%. towards the end of the study period, early 2023. In total, the NIH authors estimate that about 135,000 hospitalizations and 48,000 deaths could have been avoided if half of the patients eligible for the antiviral had obtained it.
Paxlovid, made by Pfizer, is a two-drug treatment meant to be taken within five days of Covid symptoms appearing to stop the spread of the virus in the body. It was approved for adults who are at high risk for severe Covid, which generally includes people 65 and older and people with diabetes, obesity, asthma and other conditions.
The reasons for not prescribing or taking it are varied: Doctors consider the long list of medications not to mix with Paxlovid, including common medications intended to lower blood pressure or prevent blood clots. Patients tend to complain about the metallic aftertaste of the drug. Many drop the drug early in Covid, when symptoms tend to be mildest, bypassing the opportunity to limit early viral growth.
“They want to wait and see if things get worse, but if you wait and see, it’s not effective,” said Dr. David Gifford, chief medical officer of the American Health Care Association, which represents nursing homes. . People think, ‘It’s just a cold and I’ll put up with it,'” he said. “And that needs to change.”
Price has also become a factor. The federal government has provided the five-day treatment free of charge in the months since its initial emergency authorization in December 2021. (The Food and Drug Administration fully approved the drug in May.) Federal officials still have more of a million free medicines. doses distributed to pharmacies, and the drugs will be free until 2024 for Medicaid and Medicare patients. But in recent weeks, officials have turned distribution of the drug over to Pfizer, which has priced it at around $1,400 per treatment, although private insurers are expected to cover part of the price and Pfizer offers co-payment assistance.
No studies have examined the effect of transfer. The NIH study period ended early last year. The study found wide regional variations in Paxlovid use, with up to 50 percent of eligible patients receiving the drug in Utah and the Northeast and Northwest regions of the United States. . However, rates have fallen near zero in the Southeast states and parts of the Lower Midwest.
Dr. Fessel, of the NIH, said it would be curious to see whether concerns about Paxlovid’s so-called rebound contributed to this. The concern is that the drug initially alleviates symptoms and then leads to a second stage of the disease.
In a recent goodbye According to studies, the Centers for Disease Control and Prevention found “no consistent association” with Paxlovid use and Covid rebound. Studies show that rebound can also occur without treatment.
Denis Nash, a professor of epidemiology at the City University of New York, has also studied the use of Paxlovid. In a distance small studyhis team also found that the rate of uptake of the drug stood at nearly 14 percent, although lower among some, including 7 percent among black people and nearly 11 percent among those at the same income levels. the lowest.
He said his team worked on a nationally representative survey of 4,000 people to dig deeper (the results have not yet been published or peer-reviewed). An interesting finding, he said, was that awareness of Paxlovid was high – with about 80 percent of respondents saying they knew it was available.
Yet those surveyed showed a lack of recognition of their own risk: only about a third of people over 65 considered themselves at high risk for severe Covid, even though the CDC considers all members of this age group are at high risk. The result was similar for patients with asthma or diabetes, although half of the overweight or obese patients acknowledged their risk.
“People don’t necessarily perceive themselves to be at risk,” Dr. Nash said.
Another recent study found that starting Paxlovid very early, or on the first day of symptoms, improved the chances of survival or avoiding hospitalization, compared to starting the drug a day or two later.
Studies have also looked at the use of another antiviral drug, molnupiravir, made by Merck, which is less effective and less frequently used. Gilead, which makes the antiviral infusion remdesivir, is also studying a Covid antiviral pill called obeldesivir and plans to seek FDA approval. The NIH is investigate yet another antiviral optionensitrelvir, from the company Shinogi, which also seems to reduce the duration of the disease.
Researchers also reported low use of Paxlovid in nursing homes, given patients’ risk of severe illness or death. Around one in four nursing home residents have been prescribed antivirals to treat Covid by the end of 2022, a study revealed. Data showed the rate moved closer to one-third of nursing home residents by May 2023, said one of the study’s authors, Brian McGarry, an assistant professor of medicine at the University of Rochester. .
After that, federal officials stopped asking about the use of Paxlovid in their weekly Covid questionnaire on nursing homes.
“I think things are a little better,” Dr. McGarry said, “but at the same time, facilities are now dealing with Covid, RSV and the flu.”