Paxlovid not yet the key to the pandemic

The link established Tuesday by Minister Dubé between the gradual abandonment of the vaccine passport and increased access to the Paxlovid treatment sows astonishment. Especially since thousands of doses of the antiviral pill are currently sleeping on the shelves of pharmacies kept secret, and that hospitals are selling theirs drop by drop because of the many contraindications linked to this new weapon against COVID.

Of the 12,500 treatments received by Quebec since January, a very small volume intended for patients at high risk of being hospitalized for COVID would have been distributed to date, according to information obtained by The duty.

“It’s coming out bit by bit. The ministry protects the stocks, and the pharmacies that have them are kept secret so that there are no thefts of this very expensive drug. We fear that there is an undue demand from the public,” confided one of the 65 pharmacists chosen in Quebec to distribute the famous Paxlovid. He requested anonymity to preserve that of his pharmacy.

According to the latter, the number of Paxlovid prescriptions filled since January remains ridiculously low, despite the presence of sufficient stocks. “It’s really not madness. I have had one or two patients so far, sent by specialized clinics, and it’s the same thing elsewhere, ”explains the latter.

Same observation in hospitals, where several doctors see Paxlovid as an exceptional treatment and are surprised that the government is considering the abandonment of the vaccine passport by evoking increased access to the antiviral pill from Pfizer.

On Tuesday, the Minister of Health, Christian Dubé, indeed made this link by adding that the arrival of Paxlovid would now make it possible to protect people at risk and the health system.

“This last stage that we are announcing today also agrees […] with the increasingly important arrival of Paxlovid, which can also be used to cure people. So we are giving ourselves the means to cure people most at risk with antivirals, but also to protect our health system. »

According to the Ministry of Health, 6,300 treatments were received in January, 6,200 in February, and 19,000 treatments are expected in March. But as of February 7, although 2,200 Paxlovid treatments had been dispensed through community pharmacies, the ministry said it did not know how many prescriptions were actually filled.

Relative efficiency

At the McGill University Health Center (MUHC), where a large volume of patients at risk of developing a severe form of COVID are treated (immunocompromised patients, transplant patients or patients with several risk factors), only about ten patients were able to receive the Paxlovid to date. But that’s because of the complexity of administering the drug, says Dr.^D Makeda Semret, Director of the MUHC Antibiotic Stewardship Program.

According to the D^D Semret, who oversees the distribution of Paxlovid and monoclonal antibodies at the MUHC, Paxlovid is not “miraculous”. Of 20 at-risk patients who receive it, only one avoids hospitalization, most studies estimate. “It’s not bad, but it’s not magic either,” she says.

Trials conducted by the manufacturer, Pfizer, have shown that Paxlovid (30 pills in five days) can reduce hospitalizations and deaths by 89% in patients at high risk of complications. Of just over 600 patients who received Paxlovid five days after being infected, 1% were hospitalized (no deaths) after 28 days, compared to 6.7% (as well as 10 deaths) in the group who received a placebo.

“There are so many contraindications and criteria for this drug, it’s not a Tylenol tablet,” says Dr.^D Semret, which does not see how it could become a general drug. “This medicine only helps if all the conditions are met, and if it is taken five to six days after the onset of symptoms. You need quick access to a PCR test, and a full pharmaceutical evaluation to ensure the safety of the drug,” she adds.

The latter misunderstands the link established between the abandonment of the vaccine passport and increased access to Paxlovid. “It’s a bit optimistic. I cannot comment on a decision that is more political than medical. »

“This drug was put on the market quickly, it remains an exceptional drug. Many people at risk do not qualify for this treatment. I doubt that it can be prescribed in pharmacies tomorrow morning, ”raises for his part the D^r François De Champlain, head of traumatology and emergency physician at the MUHC.

Pharmacies ready

Despite everything, the Quebec Association of Proprietary Pharmacists (AQPP) believes that it is urgent to expand access to this antiviral drug. “We have too many unused treatments in our pharmacies, and there will soon be even more. It doesn’t roll enough. Now that the wave of infections is decreasing, let’s use what’s on the shelves,” says AQPP president Benoît Morin.

Currently, Paxlovid is mainly prescribed to patients coming from specialist hospital clinics, especially those with immunodeficiency or high risk factors, such as obesity, diabetes, various other diseases and pulmonary or heart failure. However, more patients could benefit from it, believes Benoît Morin.

“At the moment, we [ne fait que revérifier] drug interactions and over-the-counter medications taken by patients, but the assessment has already been done in the hospital. Nothing would prevent the pharmacist from starting the treatment one day if Paxlovid is prescribed to a larger clientele. There, we are still in a heavy process, ”he says.

The D^r Réjean Thomas, director of the L’Actuel clinic, which treats several patients with HIV, also deplores the fact that Paxlovid is concentrated in hospitals. “HIV patients with immunodeficiency are followed by family doctors. We did not think of this clientele, which is also at risk of complications from COVID. »

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