WHO ‘strongly recommends’ oral antiviral for at-risk patients with non-severe Covid

The World Health Organisation (WHO) ‘strongly recommends’, Pfizer’s oral antiviral drug for patients with non-severe Covid-19 who are at highest risk of hospitalisation, such as unvaccinated, older, or immunosuppressed patients.

The combination of nirmatrelvir and ritonavir, experts say, represent a ‘superior choice’ for these patients, as it may prevent more hospitalisations than alternative drugs, has fewer potential harms than molnupiravir, and is easier to administer than intravenous options.

However, the drug is not recommended for patients with severe Covid, as there are no trial data. They also do not recommend nirmatrelvir/ritonavir for patients at low-risk, as the benefits are ‘trivial’.

Oral antivirals reduced hospital admission by 84 admissions per 1,000 patients.

The recommendation is based on new data from two randomised controlled trials (RCTs) involving more than 3,000 patients, which found the oral antiviral reduced hospital admission by 84 admissions per 1,000 patients.

There was little evidence to suggest that the drug affected mortality rates, however, there was high certainty evidence that the drug caused any severe adverse affects.

In the same guideline, the WHO made a weak recommendation for the use of remdesivir (an intravenous drug) for patients with non-severe Covid-19 at highest risk of hospitalisation.

This was based on data from five RCTs, and replaces a recommendation against treatment with the drug for patients with Covid-19 regardless of disease severity.

Uncertainty regarding the emergence of resistance

The WHO recommend that the antivirals are administered as early as possible in the course of the disease, but note that there remains uncertainty regarding the emergence of resistance.

They also acknowledge that low- and middle-income countries may struggle to access the drug due to cost and resource implications.