Paxlovid for covid-19: The practitioner will decide on the deployment

“The administration of antivirals against SARS-CoV-2 is indicated by a doctor with specialized qualifications (general practitioner, ambulatory specialist, hospital doctor). When choosing a suitable antiviral drug, they will take into account the effectiveness achieved in clinical trials, contraindications and potential drug interactions,” said Ondřej Jakob, spokesman for the Ministry of Health, when asked by Novinek which patients the new type of covid drug would be suitable for.

The next covid drug will arrive in September

Homemade

According to him, the attending physician should, in addition to the summary of available information, also rely on the Interdisciplinary opinion of professional societies, which specifies groups of patients for which treatment with which medicinal product is suitable.

It also follows that antivirals should be provided to patients with proven mild and moderate covid-19 who, due to other circumstances, have a high risk of developing the disease into a severe form requiring hospitalization.

As with the previous treatment with monoclonal antibodies, it is crucial that the drug is used in time, before the infection has fully affected the patient’s body.

Criteria for the indication of the drug paxlovid according to the Ministry of Health:

  • adults from 18 years of age
  • positive test for SARS-CoV-2 (antigenic or PCR)
  • within 5 days of the onset of covid-19 symptoms
  • the patient’s clinical condition does not require hospitalization for covid-19 (patients who are hospitalized for a reason other than covid-19 are subject to submission criteria as non-hospitalized persons)
  • the patient’s clinical condition does not require therapeutic oxygen administration for covid-19
  • the patient’s long-term prognosis is evaluated as favorable

“The doctor then takes the given recommendations into account in relation to the general state of health of the given patient and his individual conditions,” summarized Jakob in general.

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In practice, however, patients and practitioners encounter, as in the case of the administration of previous monoclonal substances, the ambiguity of the ministerial regulation. And the practitioners who ultimately prescribe the medicine often decide according to their own will, even if the patient formally meets the ministerial criteria.

For example, although the mentioned rules talk about a positive antigenic or PCR test, in practice, general practitioners condition the prescription of paxlovid by passing only a PCR test, they do not recognize home antigenic tests. However, this can be a significant complication, especially for older and less mobile patients.

In these cases, the Ministry refers to a possible alternative solution. “If the doctor indicates the need to perform a PCR test, it is not absolutely necessary for the patient to come to the sampling point of the laboratory. The recommendation is that in the case of an indication for a PCR test in the patient being examined, a general practitioner should take a sample and then send this sample to the laboratory,” the ministry said in response to Novinek’s earlier question regarding the conditions for the use of monoclonal antibodies.

The next covid drug will arrive in September

Homemade

However, this rarely happens in practice, and practitioners only refer patients to testing centers.

However, even if the aforementioned criteria are met, the general practitioner does not have to prescribe the drug, the price of which the Ministry does not want to specify, to the patient. In such a case, according to the recommendations of the Ministry, he can also contact an outpatient specialist, or a doctor in a hospital in an application center. However, this will delay the initiation of treatment again and there is a risk that the patient belonging to the risk group will be significantly burdened in the meantime.

The Ministry of Health concluded a contract with the American company Pfizer for the supply of the antiviral drug paxlovid for covid-19 until the end of this year.

Jakob previously told ČTK that, according to him, it is impossible to disclose the amount that the drugs will cost due to the confidentiality regime of the contract. Originally, it was interested in 50,000 benefits for a billion crowns.

In Slovakia, they took over the first batch already in August. In total, they ordered 25,000 packs of paxlovid and paid 18.2 million euros (455 million crowns) for it, local media reported, referring to the published contract. Converted to Czech crowns, one pack of Slovaks costs about 18,000 crowns.

The article is in Czech

Tags: Paxlovid covid19 practitioner decide deployment

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