Review Article

Safety and Efficacy of Paxlovid in COVID-19 Treatment: A Rapid Review

Abstract

Abstract
Context: In the first stage of viral replication, COVID-19 may cause a remarkable inflammatory response in patients. Paxlovid is an oral antivirus medicine that functions through the inhibition of one of the essential enzymes to viral replication, called protease. The present study intends to help policymakers decide on using Paxlovid in COVID-19 treatment.
Evidence Acquisition: This rapid review searched databases including Cochrane, PubMed, and Google Scholar by the end of July 2022. The inclusion criteria were randomized clinical trials investigating the safety and effectiveness of Paxlovid oral medicine at different doses in COVID-19 patients, compared with placebo or other routine care methods.
Results: Based on the results (from three studies meeting the inclusion criteria), Paxlovid has no serious side effects, but when used, the patients must be checked for renal and hepatic failure, as well as drug interactions. Patients treated with this medicine within five days after the symptom onset were hospitalized, with 1% (6/607) in the Paxlovid group and 6.7% (41/612) in the placebo group. Also, no fatalities were reported in the Paxlovid group until day 28, while 10 (1.6%) patients died in the placebo group.
Conclusions: Paxlovid is very effective in outpatient treatment and comes in a combination pack containing nirmatrelvir 150 mg and ritonavir 100 mg film-coated tablets, to be taken twice daily for five days after the symptom onset in adults and children (over 12 years old and a minimum weight of 40 kg) who have mild to moderate symptoms of COVID-19 in order to prevent severe disease, which may lead to hospitalization and death. However, there is high uncertainty about the possibility of drug interactions.
Keywords: Paxlovid; Rapid Review; COVID-19; Pandemic; Health Technology Assessment

References
1) Jaafarabadi, M., Bagheri, M., Shariat, M., Raeisie, K., Ranjbar, A., Ghafoori, F., & Haghollahi, F. (2020). The evaluation of clinical symptoms and underlying factors in infected patients with COVID-19. Tehran University Medical Journal TUMS Publications, 78(10), 668-677.‏
2) Nirmatrelvir/ Ritonavir (Paxlovid) What Prescribers and Pharmacists Need to Know. University of WATERLOO.
3) Assessment report of Paxlovid. www.ema.europa.eu
4) https://www.fda.gov/news-events/press-announcements/coronavirus-COVID-19-update-fda-authorizes-additional-oral-antiviral-treatment-COVID-19-certain
5) https://www.gov.uk/government/publications/regulatory-approval-of-paxlovid/summary-of-product-characteristics-for-paxlovid]
6) EUnetHTA Rolling Collaborative Review (RCR19) Authoring Team. Molnupiravir for the treatment of COVID-19. Diemen (The Netherlands): EUnetHTA; 2021. [date of citation]. 25 pages. Report No.: RCR19, v6.0. Available from: https //www.eunethta.eu.
7) BMJ 2021;375:n2713. http://dx.doi.org/10.1136/bmj.n2713. Published: 8 November 2021
8) https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirusinfection/guidance-documents/considerations-nirmatrelvir-ritonavir-paxlovid.html
9) https://www.nytimes.com/2021/12/14/health/pfizer-COVID-19-pill-paxlovid.html
10) https://www.nytimes.com/2022/01/19/business/COVID-pill-treatment-pfizer.html
11) Komorowski AS, Tseng A, Vandersluis S, et al. Evidence-based recommendations on the use of nirmatrelvir/ritonavir (Paxlovid) for adults in Ontario. Science Briefs of the Ontario COVID-19 Science Advisory Table. 2022;3(57). https://doi.org/10.47326/ ocsat.2022.03.57.1.0
12) Hung, Y.-P.; Lee, J.-C.; Chiu, C.-W.; Lee, C.-C.; Tsai, P.-J.; Hsu, I.-L.; Ko, W.-C. Oral
Nirmatrelvir/Ritonavir Therapy for COVID-19: The Dawn in the Dark? Antibiotics 2022, 11, 220.
https://doi.org/10.3390/ antibiotics11020220
13) Wen, Wen, et al. "Efficacy and safety of three new oral antiviral treatment (molnupiravir, fluvoxamine and Paxlovid) for COVID-19： a meta-analysis." Annals of medicine 54.1 (2022): 516-523.‏
Files
IssueVol 6, No 1 (2022) QRcode
SectionReview Article
DOI https://doi.org/10.18502/htaa.v6i1.11131
Keywords
Paxlovid Rapid Review COVID-19 Pandemic Health technology assessment
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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Mobinizadeh MR, Akbarisari A, Olyaeemanesh A, Mohammadshahi M, Ahmadnezhad E, Aboee P, Gharib Naseri Z, Fakoorfard Z, Sadeghi R. Safety and Efficacy of Paxlovid in COVID-19 Treatment: A Rapid Review. Health Tech Ass Act. 2022;6(1).