Coronavirus: treatments are progressing painfully

Although it is declining in a large majority of countries, Covid-19 has not disappeared, and, in addition to vaccines, drugs can make a difference for the patients most at risk.

These treatments, those to prevent and those to cure, concern people for whom the vaccine is only slightly or not effective (immunocompromised, etc.) or who have a high risk of serious forms and death, including the oldest.

But for now “This is mineeffective drugs remain insufficiently used, proof of this is the number of deaths”, regrets to AFP Antoine Flahault, director of the Institute of Global Health and professor at the Faculty of Medicine in Geneva.

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“The main obstacle remains logistics”according to him. “The people concerned must think about doing a PCR test in the event of symptoms or contact at risk, the attending physician must think about prescribing the appropriate medicine, the pharmacy has it available within the short time required, the hospital can receive and treat patients” for drugs administered in hospital.

Pills

First category of treatment, antiviral pills act directly on the virus to prevent its multiplication.

Against the Covid, the most advanced is Pfizer’s Paxlovid. The World Health Organization recommended a week ago that it be favored over other treatments, including Merck’s less effective competing pill, molnupiravir.

And China gave Paxlovid its conditional green light in mid-February. Good news for Pfizer, which plans to produce 120 million doses this year and has already made $72 million last year for a much smaller quantity.

But, for now, doctors are struggling to prescribe these pills. In France, where Paxlovid is the only authorized antiviral, 3,500 treatments were prescribed out of 100,000 delivered in the first trimester. To deploy it further, the authorities want to facilitate its prescription.

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Likewise, in the United States, the administration of Joe Biden has taken measures for the accessibility and recognition of anti-Covid pills. And Vice President Kamala Harris, who tested positive for Covid on Tuesday, takes the Pfizer pills.

Still, several brakes are raised by specialists. First, the race against time to administer them: ideally less than five days after the onset of symptoms, confirmed by a test.

Certain drugs, starting with Paxlovid, are also “delicate to use” due to “many interactions with other drugs”specifies Antoine Flahault.

Another limit: certain variants, such as Omicron, can reduce its effectiveness.

Synthetic antibody

Second major category, monoclonal antibodies must be administered, by infusion or injection, in the hospital. They can decrease the risk of hospitalization and death by up to 80%.

These treatments, which target only one part of the virus, are used in two ways, depending on the drug chosen. Either they are used preventively in people who cannot be vaccinated, or they are given to hospitalized patients to prevent their Covid from degenerating into complications.

The main ones are Evusheld from the Swedish-British AstraZeneca and Ronapreve from the Swiss Roche, both used preventively, the second also curative. Added to this, as a curative, is Xevudy from Britain’s GlaxoSmithKline and American biotech Vir.

Here again, the deadlines for administering them are tight.

And, even more than the pills, several of these biomedicines lose effectiveness over the variants.

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“The monoclonal antibodies effective against the Delta variant are no longer effective against Omicron-BA.1, the one that remained effective against BA.1 is no longer effective against BA.2”a difficult pace to follow for research and prescription, notes Antoine Flahault.

If Evusheld still seems to protect against Omicron, a higher first dose is sometimes recommended to compensate for its lower effectiveness. Ronapreve is almost abandoned in several countries, given the total loss of neutralizing activity.

Poor countries

As with vaccines, access to anti-Covid drugs remains very unequal between rich and poor countries. The lifting of patents was debated here again, with some advances.

In the fall of 2021, Pfizer and Merck announced licensing agreements under the aegis of the UN, making it possible to manufacture a less expensive generic version of their pills. Agreements were thus signed in mid-March with 35 generic manufacturers in Europe, Asia, Central and Latin America to manufacture Paxlovid and supply it to 95 poor countries.

But the WHO said to itself, last Friday, “very worried” less affluent countries still find it difficult to access Paxlovid. She “strongly recommended” that Pfizer go further with more transparent pricing and contracts and an expanded license base so more generics can produce the drug.

NGOs are still fighting. “As new treatments emerge, it will simply be inhumane if they are not available in resource-limited settings, simply because they are patented and too expensive”warned, in early 2022, Marcio da Fonseca, an adviser for MSF’s Access to Medicines Campaign.

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