Frankfurt, Berlin New antiviral agents, most notably Pfizer’s drug Paxlovid, are taking on a more prominent role in the fight against Covid-19. In the USA in particular, the number of prescriptions is now increasing significantly. However, it remains questionable to what extent the quantities ordered by numerous governments are actually used – and to what extent the drugs help to reduce the burden of disease and mortality rates.
Countries around the world may have ordered more than 40 million packs of Paxlovid and several million units of the other corona drugs. Based on orders so far, Pfizer expects sales of the drug to be around $22 billion this year.
Analysts believe that Paxlovid will continue to generate high, albeit declining, revenues in the coming years. The market researcher Global Data, for example, recently estimated that Pfizer’s revenues could add up to a good 80 billion dollars by 2028.
The use of the drug in practice was initially very hesitant, but has accelerated in recent months, especially in the USA. According to the latest information from the US Department of Health, around 7.6 million doses of Paxlovid were delivered there by mid-September and a good 4.6 million doses were also prescribed.
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Around half a million units each were used by other Covid drugs. These include Merck & Co.’s antiviral drug, Lagevrio, and antibody preparations from Eli Lilly and Astra-Zeneca.
US government ordered in a big way
In total, the US government has ordered 20 million Paxlovid treatment units from Pfizer to date. In view of the increasing number of prescriptions, the Ministry of Health now assumes that these will be used up by the middle of next year.
Booster for the balance sheet
According to analyst estimates, the US group Pfizer could take Paxlovid by 2028.
This should be the case even earlier with other Covid drugs such as Lagevrio and Evusheld from Astra-Zeneca, of which significantly smaller quantities were ordered. After phasing out, distribution in the USA will probably take place via the regular pharmaceutical trade.
In Germany, too, Paxlovid is now apparently being used more frequently than in the first half of the year. According to the Federal Ministry of Health, an average of around 10,000 therapy units per week have been delivered to wholesalers since the beginning of September, compared to only around 3,500 units each before.
Medical practices, hospitals and inpatient care facilities have recently been able to order and keep several packs of Paxlovid through their regular pharmacy. In this way, the tablets should reach the patient more quickly and easily. Health Minister Karl Lauterbach (SPD) announced this at the end of August in order to facilitate the delivery.
The effects of using Paxlovid are difficult to estimate
According to data from market researcher Iqvia, around 47,000 packs of Paxlovid were prescribed in Germany by July. In total, the federal government had bought one million packs by the end of 2021. This means that even after the recent acceleration of deliveries, the stock is far from exhausted.
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To what extent the use of antiviral drugs has reduced the number of severe courses and deaths from Covid-19 is difficult to see for the time being. Because other factors such as higher vaccination rates and the generally more harmless course of the disease in the Omicron variants also play a decisive role here.
In clinical trials, Paxlovid reduced the likelihood of hospital admissions or death by almost 90 percent in patients at increased risk of severe disease. US President Joe Biden was also recently treated with the drug after his corona infection. In contrast, the drug did not show a statistically significant benefit in normal-risk patients. Corresponding studies were therefore discontinued by Pfizer in June.
Study shows no benefits in younger patients
Despite the increased use of Paxlovid and other antiviral agents, the mortality rate from Covid diseases in the USA is still significantly higher than in Germany, for example, where antiviral agents have so far been prescribed much more cautiously. For the last three months, the figure for the USA was 0.42 percent of all cases of infection, compared to 0.16 percent in Germany.
Packs of Paxlovid
was sold by the federal government at the end of 2021. According to data from market researcher Iqvia, around 47,000 packs were prescribed by July.
After all, the mortality rate in the USA has been falling continuously since last year, while in Germany it has remained stable at a low level and recently increased again slightly.
The first more detailed analyzes from practice also show that the doctors’ hesitation in prescribing is not entirely unfounded. While the use of Paxlovid can significantly reduce the risk of serious disease in older people, it may not be so in younger people under the age of 65.
At least that is the result of an observational study from Israel recently published in the respected New England Journal of Medicine. Paxlovid reduced the risk of hospitalization for Covid-19 by 67 percent and the risk of death by 81 percent in older people. However, no significant reduction in severe cases has been observed in younger adults, write the researchers led by Ronen Arbel.
A total of around 109,000 people who fell ill between January 9 and February 24 were included in the analysis, i.e. in a phase when the omicron variant was already dominant. Around four percent of these patients were treated with Paxlovid.
Among those over 64 years of age, 14.7 hospitalizations per 100,000 people were observed in the Paxlovid group compared to 58.9 cases in the untreated group. However, this difference was not observed in younger people. Here the hospitalization rates were almost identical at 15.2 to 15.8.
A major challenge to the use of Paxlovid is that it can interact with and reduce the effects of numerous other drugs. The Pfizer drug basically consists of two tablets, the actual antiviral substance nirmatrelvir and the additional active ingredient ritonavir, which in turn is responsible for the interactions.
The official instructions for use list around two dozen classes of drugs that could be problematic when taken with Paxlovid. These include common drugs such as blood thinners and high blood pressure medication, which are often routinely used in the treatment of older people. This in turn makes it more difficult to use, especially in the group of patients who could benefit most from the drug.
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