The World Health Organization said Friday that the “highly recommended” Pfizer COVID-19 antiviral pill Paxlovid for patients with milder forms of the disease, who still had a high risk of hospitalization.
However, the UN agency warned that it was “extremely concerned” that inequality in access seen with COVID-19 vaccines would again leave low- and middle-income countries “pushed to the end of the queue.”
The combination of nirmatrelvir and ritonavir by the US pharmaceutical giant Pfizer was the “superior choice” of treatment for unvaccinated, elderly or immunocompromised people with COVID-19, said WHO experts in the medical journal BMJ.
For the same patients, the WHO also made a “conditional (weak) recommendation” of the antiviral drug remdesivir, made by the American biotech company Gilead, which it had previously recommended.
The WHO recommended Paxlovid over remdesivir, as well as over Merck’s molnupiravir pill and monoclonal antibodies.
Pfizer’s oral treatment prevents hospitalization more than the “available alternatives, has fewer injury concerns than molnupiravir, and is easier to administer than intravenous belt disivir and antibodies,” WHO experts said.
The new recommendation was based on the results of two trials with almost 3,100 patients, which showed that Paxlovid reduced the risk of hospitalization by 85%.
The trials “also did not suggest any significant difference in mortality” and “little or no risk of side effects that led to discontinuation of medication.”
The recommendation applies to people over the age of 18, but not to pregnant or breastfeeding women.
Nor does it apply to patients at low risk of complications from the disease because the benefit would be minimal.
WHO experts also refused to give an opinion to patients with severe forms of the disease due to lack of data.
The WHO stressed the limitations of such antiviral treatments.
“The medicine can only be administered while the disease is in the early stages,” they said.
This means that patients must quickly test positive and have the pill prescribed by a doctor – all of which can constitute obstacles for low- and middle-income countries, the WHO said.
Still, COVID-19 pills have been seen as a potentially big step in ending the pandemic, as they can be taken at home instead of in the hospital.
Patients should start taking their Paxlovid pills within five days of the onset of symptoms – the course then lasts five days.
Remdesivir can be taken within seven days after the onset of symptoms, but it is administered intravenously over three days.
WHO urged Pfizer to “make its pricing and agreements more transparent” for Paxlovid.
Lisa Hedman, WHO’s senior adviser on access to medicines, said that the radio station NPR reported that a full cure with Paxlovid costs $ 530 in the United States. Another source, not confirmed by the WHO, gave the price of $ 250 in a country of upper middle income.
Belt straps meanwhile cost $ 520, Hedman said, but generic versions made by companies in India sell for $ 53- $ 64.
There is also a question as to whether the virus can build up resistance to these treatments.
But earlier this month, Pfizer’s CEO Albert Bourla predicted a bright future for treatments like Paxlovid’s as people get tired of getting additional booster vaccinations.
Pfizer has come under fire for prioritizing rich countries with its vaccine, and Pfizer has agreed to allow some generic drug manufacturers around the world to make cheaper versions of Paxlovid under a UN-backed scheme.
But on Friday, the WHO strongly recommended that Pfizer let more generic manufacturers produce the drug and “make it available more quickly at affordable prices.”