At the start of the Covid-19 epidemic, it was long believed that treatments would arrive before vaccines. But thanks to 30 years of past research, and the determination of the German couple at the head of BioNTech, in Germany, and a small part of luck, it is finally the opposite that happened.
Several discontinued treatments
Research on treatments has since not stopped. And fortunately: the virus always seems to circumvent the antibodies a little better with each mutation, part of the population refuses vaccination, which remains a privilege of developed countries.
In some very immunocompromised people (elderly, transplanted, under immunosuppressive treatment, suffering from cancer…), finally, the vaccine is rendered totally ineffective.
Several treatments are under development – even are now authorized. Others, effective in the past, no longer work with current variants, including Omicron.
Paxlovid, after an infection for those most at risk
On January 27, the European Medicines Agency (EMA) announced that it had approved Pfizer’s anti-Covid pill, the famous “Paxlovid”. In France, a decree has been published to authorize its marketing.
The first 10,000 doses of Paxlovid were received on February 1. France has ordered 500,000 doses
The Ministry of Health
This is the first oral antiviral treatment – that is to say in the form of tablets – against Covid-19 to be authorized within the European Union.
This product, a priori always effective against the Omicron variant, significantly reduces the risk of hospitalization and death in patients at risk of developing a severe form, and in whom vaccination remains ineffective or insufficient – very immunocompromised, therefore.
It works by limiting the ability of the virus to replicate. The EMA recommends the use of Paxlovid “for the treatment of Covid-19 in adults who do not require supplemental oxygen and who are at increased risk of the disease becoming serious”.
We observe “a reduction in the occurrence of hospitalization or death of 85.2% for patients, provided that it is administered as soon as possible and within five days of the appearance of the first symptoms”, specifies the firm of Olivier Véran.
What, a priori, contribute to limit the hospital saturation: it is enough to swallow it with a glass of water.
A complex prescription
Paxlovid combines a new molecule, PF-07321332, and ritonavir, an antiviral already used against HIV, to be taken in the form of three separate tablets. Ritonavir serves as a “booster” to increase the effectiveness of Paxlovid, allowing it not to be metabolized by the liver before its action.
Attention, warns the High Authority of Health: this treatment can in no case be used “as a substitute for vaccination”. For example, it is contraindicated in people with severe hepatic insufficiency or severe renal insufficiency, and in a multitude of other situations.
It also presents serious risks in the event of drug interaction with many sometimes very common molecules. Its notice, published on the ANSM website, provides a long list of warnings.
It will be difficult to prescribe, and to dose, there are multiple contraindications, there are many precautions to take, because it is a drug intended for patients already under other treatments
Mathieu Molimard, head of the pharmacology department at the Bordeaux University Hospital, on France Info
It can only be prescribed by a doctor on consultation, with a dedicated and very secure procedure, in order to be administered at the right time – within five days of infection – only to eligible people.
Preventive injection treatment
Other treatments existed, such as the preventive “Ronapreve”, developed by Regeneron with the Roche laboratory. Or the “Lilly” (bamlanivimab / etesivimab), already considered “not optimal” against Delta. But they are no longer effective against the Omicron variant.
On the other hand, the Evusheld produced by AstraZeneca has now been available since mid-December. It is a drug used as a preventive measure for people who do not respond to vaccination – therefore severely immunocompromised -, administered in the form of an injection every six months.
We have reserved 50,000 doses, we have more than 6,500 patients treated at the moment. It retains effectiveness against Omicron
The Ministry of Health
The anti-Covid pill produced by the American manufacturer Merck is still awaiting authorization.
A curative treatment to take quickly
At the beginning of January, the HAS also authorized Xevudy (sotrovimab) from the GlaxoSmithKline (GSK) laboratory, validated at European level in mid-December.
It is a treatment with monoclonal antibodies intended for adults but also for adolescents over the age of twelve, provided they weigh more than 40 kg. Again, it is only reserved for patients who do not need oxygen supplementation, but who are at high risk of a serious form.
It remains, for the time being, the only treatment with synthetic monoclonal antibodies available as a curative against the Omicron variant. Provided you meet the deadlines:
It is recommended to administer it within five days of the onset of symptoms
The High Authority for Health
Xevudy, which is administered intravenously, joins the list of synthetic antibody treatments, several of which have already been authorized since the start of the pandemic. But he is now the only one to remain effective against Omicron:
To date, it is the only monoclonal antibody treatment authorized as a curative and whose neutralizing activity should be retained against the Omicron variant
ANSM
No miracle treatment
In short, as Professor Mathieu Molimard reminds us, to date there is no miracle treatment against Covid-19: the only molecules used are for very specific profiles, and with many risk factors. Both their prescription and their administration remain complex.
Vaccination, even imperfect, remains the best protection for the entire population: even with the Omicron variant, it halves the risk of infection and the risk of hospitalization by ten.
The current molecules are also intended primarily for severely immunocompromised patients, in whom the vaccine is totally ineffective.