Should I take an antiviral for COVID-19?

Oith the Omicron variant still circulating widely around the world and home testing for COVID-19 becoming increasingly popular, more and more people are testing positive for SARS-CoV-2. It leaves them wondering if there is anything they can do to reduce the number of their sick days and, more importantly, reduce the risk of becoming seriously ill. Here is a list of available treatments, who should use them and when.

Can anyone who tests positive for COVID-19 benefit from drug treatment?

At this time, COVID-19 therapies are not intended for the vast majority of people who might test positive. They target people with underlying health conditions, who might not have as strong an immune response to vaccines, or older people, all of whom are more likely to develop symptoms severe enough to require hospitalization. Researchers are studying the risks and benefits of the therapies, however, to determine whether expanding treatments to include more people who test positive is both safe and effective.

How many drug therapies are available to treat COVID-19?

Drug treatments for COVID-19 basically fall into one of two categories: monoclonal antibodies or antivirals.

Monoclonal antibodies are compounds that mimic parts of the immune cells that SARS-CoV-2 infects. With enough monoclonal antibodies floating around, the virus binds to these drugs instead of healthy cells, drastically reducing the number of healthy cells that eventually become infected and become factories to make more virus.

There are currently four such therapies cleared by the FDA:

  • Tixagevimab and cligavimab
  • Sotrovimab
  • Bamlanivimab and etesevimab
  • Casirivimab and imdevimab

Only the first therapy remains effective in protecting against the Omicron variant.

Antivirals work by preventing the virus from using the machinery of a healthy cell to copy its genetic material and reproduce. In October 2020, the United States Food and Drug Administration (FDA) approved the first COVID-19 antiviral, remdesivir, manufactured by Gilead, after issuing an emergency use authorization for the drug in May 2020. It is an IV medication that cannot be given in hospitals or infusion clinics.

In December 2021, the FDA cleared Pfizer’s first antiviral pill, Paxlovid. Paxlovid is actually a combination of two drugs, one that stops SARS-CoV-2 from replicating and the other that stops the body from breaking down the old drug too quickly. Paxlovid is recommended for people at high risk of developing life-threatening or otherwise serious COVID-19 disease; the treatment consists of taking three tablets twice a day, for five days.

Just a day after issuing clearance for Paxlovid, the FDA also cleared Merck’s second COVID-19 antiviral pill, molnupiravir. It works by introducing genetic errors into the viral copying process. As with Paxlovid, molnupiravir is for people at risk of developing severe COVID-19 disease; the latter, however, involves taking four capsules twice a day, for five days.

How effective are antibody treatments?

Research to date suggests that monoclonal antibodies can reduce the risk of hospitalization and death by up to 80% compared to people not taking the drugs.

The problem with these therapies, however, is that SARS-CoV-2 can easily mutate around them. The FDA has approved four such therapies, but three of them are not effective in protecting against the Omicron variant. The National Institutes of Health is urging doctors to prescribe only one of the licensed therapies, Evusheld (a combination of tixagevimab and cilgavimab given as two injections), made by AstraZeneca. In a study published April 20 in the New England Journal of Medicineresearchers led by a team from AstraZeneca found that the company’s two-drug combination reduced the risk of COVID-19 symptoms in vulnerable people by nearly 77% compared to those given a placebo.

How effective are antiviral treatments?

Antivirals are also quite effective; studies have shown that Paxlovid can reduce the risk of hospitalization by more than 90% in those most vulnerable to the disease. Molnupiravir is much less effective in reducing the risk of hospitalization and death if taken several days after the onset of symptoms, but much more effective if used earlier in the course of illness, which reduces this risk of 30% to 50% in those taking the drug. compared to those who do not use it.

When should I take these treatments?

Due to how monoclonal antibodies and antivirals work, both should be taken very close to when a person is infected, preferably before they even show symptoms, and ideally within five days of the onset of diagnosis. or symptoms. The earlier the drugs enter the body, the more powerful they can be in defeating the SARS-CoV-2 virus before it can take over the immune system.

For those who never feel sick enough to need them, the drugs might not be necessary. However, for those who become ill, but not immediately after infection, it may be more difficult to start any of these therapies at the right time, as they all require a doctor’s prescription. The Biden administration’s Test-to-Treat program is intended to streamline access to drugs, but it hasn’t proven to be that effective.

And all of this is reserved for those most vulnerable to developing severe COVID-19. For most people who are able to recover from an infection without serious adverse effects, further studies are needed to assess the safety and effectiveness of antiviral treatments, especially against newer variants like Omicron.

These ongoing studies are also looking at the symptoms of Long COVID, to see if the longer-lasting effects of even mild illness could negatively affect people’s health. If so, that would make a stronger case for expanding the population that can be treated with COVID-19 therapies.

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