Paxlovid: Some medical professionals eager to see criteria expanded

Monteal–Is it time to expand access to Paxlovid, a treatment that reduces the symptoms, the risk of hospitalization and the risk of death from COVID-19? Some health professionals believe so, now that the treatment is available in sufficient quantities, but that the prescription criteria remain very restrictive. “I think we are being too cautious,” says microbiologist Dr. Karl Weiss, infectious disease specialist at the Jewish General Hospital in Montreal, in an interview with the Canadian Press. "I prescribed a lot of Paxlovid to a lot of people. Of course to patients at risk," he says, but also to others who did not necessarily meet the criteria established by l'Institut national d'excellence en santé et en services sociaux (INESSS). "I sometimes prescribed it to people who did not meet the criteria, but who, in my opinion, had clinically severe criteria, because they were doubly vaccinated but they had other important factors and then they were sick. I I said to myself: 'I better treat them before they land in the emergency room.'” he admits candidly. Very restrictive criteria In Quebec, the directives of the Ministry of Health and Social Services limit the treatment to certain very restricted groups of patients. These guidelines were established based on criteria established by the INESSS. Approved by Health Canada last January and delivered in tiny quantities—6,000 treatments for all of Quebec initially—Paxlovid was initially authorized only for immunosuppressed people and non-vaccinated people who presented risk factors for complications. These criteria had been widened slightly in February and again in March, but have not changed since. “It is normal that in the beginning there was first a limit on the quantity of drugs that were available. There was also an unknown on the part of many doctors on the capacity to use the drug,” explains Dr. Weiss. He also notes that even the INESSS has given some leeway to prescribe to people who fall outside the criteria, but who may be at risk according to the doctor's clinical judgment. "There is a certain code that we can put that allows us to prescribe the drug. There is still a certain latitude. INESSS was correct on that," he says. 115,000 doses received in Quebec There's no longer a real issue of availability. The ministry confirmed that Quebec has so far received 115,000 Paxlovid treatments and that only 14,900 have been dispensed in pharmacies. In an email to the Canadian Press, the ministry adds that to this number "are added the treatments used directly in health establishments. In this regard, we do not have data on the Paxlovid treatments served or used in health establishments." Although he does not want to risk giving an absolute figure, Dr. Weiss nevertheless asserts that the establishments certainly did not come close to exhausting the stocks. "It's definitely a few thousand treatments. But even if you got to 20,000, you see we still have a lot of room to manoeuvre," he says. Pharmacists follow the INESSS Benoit Morin, president of the Quebec Association of Proprietary Pharmacists (AQPP), explains that pharmacists, who now have the right to prescribe Paxlovid themselves, are sticking to the INESSS guidelines for the time being. "We have an organization chart drawn up by the INESSS that we must respect and which testifies to these exclusions. Yes, that means that there are a lot of people who would like it and who don't have it," he says. Morin does not hide, however, that he is eager to see new data on Paxlovid. "Some people need to be collected on the risks, the side effects, to see if we can't reduce these restrictions and increase the target audience, because if it's ever a very safe treatment, people could benefit, that's for sure. "Could, for example, older people who have been vaccinated, but who develop less immunity to the vaccine, be able to benefit? That's what the data will tell us." No turning back He cautions, however, to avoid pushing too hard, too fast because, when it comes to getting new treatments approved, it's always hard to get the toothpaste back in the tube. "Before you give the go, you need to have more hard data because there's no going back afterwards. When you let it go and take risks, if something happens, at a big scale it can be dramatic," says Morin. This article has been translated from its original French.

Paxlovid: Some medical professionals eager to see criteria expanded

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