One of the best tools for preventing severe complications from COVID infection is the prescription antiviral drug Paxlovid.
But not nearly as many people who could benefit from it are being prescribed it, says Amesh Adalja, MD, FIDSA, a senior scholar at the Johns Hopkins Center for Health Security who specializes in infectious diseases and pandemic preparedness.
Adalja says that both patients and providers need to be better informed about the benefits of Paxlovid and other antivirals like it.
Paxlovid is extremely effective when taken within five days of symptom onset. In clinical trials, it reduced the risk of hospitalization and death by almost 90% in unvaccinated people. “It’s a tremendous tool that’s completely underutilized,” says Adalja.
How does Paxlovid work?
“Paxlovid is a class of antiviral drug called a protease inhibitor,” explains Adalja. It prevents the SARS-CoV-2 virus, which causes COVID-19 infection, from replicating in the body. At a molecular level, “Paxlovid works by disrupting the protein cutting process of SARS-CoV-2,” he explains. “It blocks an essential step in the virus’s life cycle.”
Who is Paxlovid recommended for?
Paxlovid is designed to benefit people at high risk of severe illness who are at least 12 years old and weigh at least 88 pounds. Its purpose is to prevent hospitalization and death, not to decrease symptoms or to help you recover faster, although patients who take it may experience one or both of those benefits.
Who is considered ‘high risk’ for severe COVID-19 illness, hospitalization, or death?
According to the CDC, people are more likely to experience severe COVID-19 illness if they are over 50 years old, unvaccinated or not up to date on COVID-19 vaccination, immunocompromised, or have certain medical conditions.
“Any medical condition such as diabetes, hypertension, heart disease, any lung condition like asthma or COPD, would be considered high risk,” says Adalja. Other common risk factors include being overweight, obese, or pregnant.
“The majority of Americans probably have some high risk factor,” he says. “A lot of people would benefit from Paxlovid just based on their weight status.”
Is Paxlovid being prescribed as often as it should be?
“Antiviral prescribing is underutilized in the United States,” Adalja says. “There are many people with high risk conditions who are not being prescribed Paxlovid [or] an alternative antiviral like molnupiravir.”
This may be due to misconceptions, including by physicians, about who should take Paxlovid. “Some might say, ‘we’re gonna wait, you don’t look that bad,’ which is a complete misunderstanding of how the drug works,” says Adalja.
Paxlovid is designed to be given early on to prevent symptoms from becoming more severe. The decision to prescribe someone Paxlovid for a COVID infection should be made based on a patient’s risk factors for severe disease, regardless of symptom severity.
The same problem exists with antivirals for influenza. “Many high-risk people do not get prescribed an influenza antiviral despite evidence that they benefit,” says Adalja.
Doctors may be more comfortable prescribing Tamiflu because they’re more familiar with it, but Tamiflu is also underutilized.
Written by Aliza Rosen.
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