Quebec is expanding access to Paxlovid treatment to people fully vaccinated against COVID-19, in particular those over the age of 70 and members of several categories of patients deemed to be at risk, if their last vaccination dates back more than six months.
Based on new observations made in the field, the National Institute for Excellence in Health and Social Services (INESSS) has revised its guidelines for the use of this antiviral treatment formerly reserved for non-vaccinated people and people vaccinated, immunocompromised or with special medical conditions.
A new decision algorithm was distributed on Tuesday to all pharmacists authorized to prescribe Paxlovid since March 2022. It considerably expands access to this treatment aimed at preventing complications and, above all, hospitalizations linked to COVID-19.
This change of course affects many people, especially all those aged 70 and over with a single risk factor, if they have been vaccinated for more than 6 months. Any septuagenarian without a risk factor whose last dose dates back more than 6 months may also receive this treatment on the advice of a health professional.
Even vaccinated teenagers and adults with certain medical conditions (immunosuppression, obesity, diabetes, heart or lung disease) can now have access to Paxlovid on the recommendation of a doctor if it has been more than 6 months since their last vaccination.
However, INESSS continues to advise against this treatment for children and adults, regardless of age and risk factors, if they were vaccinated less than 6 months ago.
The organization says in particular to revise its recommendations because of the results of a study conducted in Quebec on the effect of the antiviral on the prevention of hospitalizations, as well as because of the circulation of current variants and “organizational issues and manpower” in the health network.
Some 22,000 treatments
According to the Quebec Association of Proprietary Pharmacists (AQPP), Paxlovid was distributed in pharmacies to 22,000 patients between March 31 and December 31, 2022. In 67% of cases, the treatment was prescribed by a pharmacist.
However, this number of treatments remains well below the total volume of 170,000 received so far in Quebec, according to figures obtained from the Ministry of Health and Social Services. The latter indicated to To have to by e-mail that “the main issue is communication to the population so that patients at risk of complications proceed quickly to a test […] and that they consult for an assessment of the need for treatment just as quickly if the test is positive”.
For several months, several health professionals have been calling for expanded access to Paxlovid given the benefits observed for certain categories of patients who are not part of those designated from the outset by INESSS.
“A lot of people haven’t gotten their booster shots and are tired of vaccines. We need to update our algorithms. Not only do we have to remind them to have an up-to-date vaccination, but we will also have to open up a discussion with these new patients about Paxlovid, in the event that they are infected,” explains Pierre-Marc Gervais, Senior Director of Pharmaceutical Services. to the Quebec Association of Proprietary Pharmacists (AQPP).
According to him, many people delay consulting and their condition can deteriorate quickly. The use of Paxlovid is then no longer relevant, because the antiviral treatment is only useful if it is started within five days of the onset of symptoms.
COVID-related deaths
More than 5,867 Quebecers died of COVID-19 in 2022. INSPQ data reveal that the vast majority of these deaths were in people over 70, mainly in those still living at home. In fact, two-thirds of deaths occurred in people who did not live in CHSLDs or RPAs, compared to 49% in 2021 and 16% in 2020.
According to Julie Racicot, president of the Association of Pharmacists in Health Institutions of Quebec, the Paxlovid always aims to prevent hospitalizations. It is not designed to treat patients who are already too ill or hospitalized with a severe form of the disease. “However, it is given in CHSLDs to patients who still have few symptoms to avoid deterioration, as well as to infected patients who are hospitalized for other reasons to avoid complications,” she says.
The AQPP, which expects an upsurge in requests due to this change of indication, however specifies that healthy people do not need Paxlovid. “Most people who have been vaccinated and who have already been infected are very well protected,” explains Mr. Gervais. They don’t need that. It remains an exceptional drug. »