Antivirals against coronavirus: what is available?

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The success of the development of coronavirus vaccines has clouded another parallel pharmaceutical race, that of the search for treatments to cure COVID-19 when we are already infected. Potential ‘lifesavers’ include monoclonal antibody therapies, as well as antivirals intended to stop SARS-CoV-2 when it replicates in our body.

The latter have been a reality for months, but not all the compounds developed have the same degree of authorization from the European Medicines Agency (EMA) and its availability remains limited. This week, the Minister of Health, Carolina Darias, called for “greater agility” from the European Union in the joint purchase of these drugs, which may be decisive in continuing to relieve pressure on hospitals.

These are the keys to the other ally of vaccines:

What antivirals exist against coronavirus?

The most ‘veteran’ and available is the remdesivir, marketed by the pharmaceutical Gilead under the brand Veklury. It is approved for the treatment of pneumonia in patients over 12 years of age and weighing 40 kilograms who already require supplemental oxygen, as well as adults at risk of the infection becoming serious. However, this second use is “pending a funding decision”, according to the Spanish Agency for Medicines and Health Products (AEMPS). Studies in this regard suggest that it would reduce the risk of hospitalization by 87% if administered before respiratory distress worsens.

In Spanish hospitals it can also be administered molnupiravir, a pill that the German laboratory Merck Sharp & Dohme (MSD) manufactures under the registered trademark Lagevrio. Although it is not yet fully authorized in the European Union, pending completion of the accelerated evaluation process, the EMA has given the green light for countries to treat adults who do not yet require oxygen but are at risk of developing Severe COVID. This oral antiviral is approved in the United Kingdom, where it is already used as one of the main treatments for vulnerable people. In Spain, on the other hand, its use must be assessed by each hospital and requested individually through the application of medications in special situations.

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On the other hand, President Pedro Sánchez has announced that Spain will buy 344,000 doses of the oral antivirals it is manufacturing Pfizer, which, he stressed, “reduce by 88% the possibility of hospitalization of vulnerable patients.” As in the previous case, the EMA Technical Committee recommends using this combination of nirmatrelvi with ritonavir called Paxlovid™ to treat adults at risk of severe COVID before symptoms worsen. This is a guarantee for “emergency” uses, while they continue to evaluate the information provided by the company to decide whether or not to grant commercial authorization.

Finally, the European Center for Disease Prevention and Control (ECDC) collects other antiviral treatments such as favipiravir, which has played a leading role in epidemics such as Ebola or the flu. Now it has been used against the coronavirus, although with less effectiveness.

When and how are they administered?

The antivirals available so far are administered in hospitals during the first five days from the onset of symptomsbefore the infection can get serious. “If you wait longer, it stops being effective, because the antiviral acts on one of the processes that lead the virus to multiply. Therefore, it makes sense in the first days of infection, when the virus is actively replicating. Later, the big problem caused by the coronavirus is inflammation. The virus ceases to be important and this class of antivirals would no longer be indicated, ”explained virologist Isabel Sola, a CSIC researcher, in an interview on TVE’s 24-hour channel.

Gilead’s remdesivir is an antiviral drug intravenous, while MSD and Pfizer have developed the first tablets. In the case of obtaining the commercial authorization by the EMA, the countries will be able to decide if the sale in pharmacies is allowed or it is limited to hospital use.

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Can I buy them at the pharmacy?

No, at the moment the antivirals available for the coronavirus cannot be bought in pharmacies in Spain, but rather are administered in hospitals and always under the discretion and supervision of the medical team. Professionals are the ones who can assess the risk-benefit, take into account the particularities of each patient and know their availability.

In any case, access varies between countries. For example, authorized treatments are funded by public health Spain, while in the United States insured patients pay more than 2,000 euros for a cycle of treatment with remdesivir. In the UK, they have gone a step further and doctors can prescribe and molnupiravir capsules to patients with risk factors (such as Down syndrome, immunosuppression, or cancer) to take at home. However, according to the website of the British National Health System, it is usually provided in hospital pharmacies.

Are they effective against the new omicron variant?

While some monoclonal antibody therapies have seen their effectiveness diminished against the new variant of the coronavirus, omicron, antivirals maintain the type. This is how Sola explained it in the interview on Canal 24 hora regarding the Pfizer pill: “one of the advantages it has is that it acts against a virus protein that intervenes in the very first stages of multiplication. Is a protease of the virus, which hardly changes between some variants and others. Therefore, it would be equally effective against different variants, even against omicron”.

Regulators in the United States on Tuesday withdrew the recommendation of two treatments against COVID-19, because they are not effective against the new version of the virus. However, it is monoclonal antibody drugs not antiviral compounds. The decision specifically affects those marketed by Eli Lilly (bamlanivimab/etesevimab) and by Regeneron (casirivimab/imdevimab).

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So, can I not get vaccinated?

Antivirals are not a substitute for vaccines. These are used for prevention, because they protect us over time against serious illness. In addition, in the event that we do get infected, research has shown that being immunized helps eliminate the virus faster. Finally, the vaccine shield against infection also reduces the chances of developing persistent COVID.

Antiviral pills, on the other hand, will be used when it is too late, we are infected and we are at risk of developing complications. These compounds are intended stop virus replication and thus help our body to kill it.

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George Holan

George Holan is chief editor at Plainsmen Post and has articles published in many notable publications in the last decade.

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