3 ms·

What's the alternative for those who are at high risk of being hospitalized or experiencing permanent damage from covid? Until there is a clear alternative, thi

by elhudy 4y ago

What's the alternative for those who are at high risk of being hospitalized or experiencing permanent damage from covid? Until there is a clear alternative, this drug probably isn't going anywhere.

AmericanChopper 4y ago
From the article: > Sarah Otto, an evolutionary biologist at the University of British Columbia in Vancouver, Canada, says the paper is another blow to the continued use of molnupiravir. She notes that a large-scale UK study found that the drug had no effect on hospitalizations or deaths
- elhudy 4y ago
  I read the article and my point still stands. Put yourself in the shoes of the patient (who largely drives their own care for these situations). You get covid, you go into the dr with a cough and say "dr, this is getting bad, and I'm obese and scared!" The dr goes, "well, we have this drug that was proven to be slightly effective in double blind placebo controlled trials. It has no adverse side-effects. But a large scale study showed it might not actually be effective. Would you like to try that?" The patient, who is probably on medicare or hit their deductible, is going to say yes give me that shit. People have been saying this same thing about the over-prescription of antibiotics for ages but nothing has changed.
  - sarchertech 4y ago
    In this case there is a much more effective drug available—-Paxlovid.
    - elhudy 4y ago
      Totally agreed, however... >There are 636 drugs known to interact with Paxlovid (nirmatrelvir/ritonavir), along with 5 disease interactions, and 2 alcohol/food interactions. Of the total drug interactions, 236 are major, 360 are moderate, and 40 are minor. Of these interactions, several are with: statins, blood thinners, hormonal birth controls, and other heart medications. The exact high-risk population who is taking these drugs, have potential interactions with paxlovid. That wipes out a significant portion of the general population from eligibility.
      - sarchertech 4y ago
        636 interactions sounds impressive. But almost any drug that’s been around for a while (like Ritonavir has) will have hundreds of interactions listed. Drug interaction databases aren’t complete nonsense, but you should take them with a huge grain of salt. The vast majority of those interactions won’t prevent a physician from prescribing Paxlovid, and for most of the rest there are either alternatives or patients can lower dosages or stop taking them for the duration of treatment.
        elhudy 4y ago
        For better or worse, I'm fairly certain statins do prevent drs from prescribing paxlovid on occasion. Happened to a family member. Tons of high risk / older Americans are on statins.
        sarchertech 4y ago
        There are statins that can be taken with Paxlovid. The general recommendations are to either to stop taking them 12 hours before through a few days after treatment or switch temporarily to one of the statins that can be take with Paxlovid.
        elhudy 4y ago
        I agree that in an ideal world, drs would recommend your course of action. I am not debating that statins can be stopped and paxlovid taken, with statins resumed after the disease has run its course. that doesnt change the fact that doctors will still hesitate to prescribe paxlovid if their patient is on statins. This could be for a number of reasons - but consider for a second that up to 55% of seniors are already noncompliant in listening to their drs and taking their medication. When you are asking a patient to stop taking a drug that they have habitually taken for potentially decades, and they have shown hesitancy or inability to comply in the past, maybe prescribing a drug with a potentially serious interaction isnt the best course of action.
        4y ago
  - keyanp 4y ago
    Or we disallow its use so it can’t be prescribed and instead the Dr gives them Paxlovid.
    - elhudy 4y ago
      see my below response re: paxlovid and its interactions
  - deleted 4y ago
    [deleted]
  - brigandish 4y ago
    > I'm obese and scared! Might I say the unsayable with not too scared to lose weight? Perhaps doctors should be ignoring the pride of their patients and telling them, after 3 years, to take their health seriously instead of waiting for the grim reaper to knock on their door? Doctors are also able to prescribe weight loss drugs, surgeries, and generally tell people what they really need to hear so we might ask why the problem persists. Maybe it's because they don't listen to advice they don't want to hear. From [1]: > The researchers found that disagreement between GPs and patients increased with patients' excess weight and was particularly pronounced for advice given by GPs on weight and lifestyle issues. Overweight patients were more likely to disagree with their GP regarding advice given on weight loss (odds ratio, 10.7), advice given on doing more physical activity (odds ratio, 1.9), and nutritional advice (odds ratio, 2.9) compared with patients with a "normal" body mass index. I'm not suggesting doctors be rude, and, as that study points out, if doctors are taking such steps and obese patients ignore them and it harms the relationship then should we not be considering other things to push them? Some people propose sugar taxes and the like but I think that still pushes responsibility away from the main cause of the problem, which is the person. Obese people should pay higher taxes and/or insurance fees that are then mitigated by efforts such as slimming classes, gym attendance etc. Or, we can continue to allow a section of society to risk their own health and mortality while putting enormous strain and cost on the health service and thus risking everyone's health and mortality. Arguing about a drug that most of them wouldn't need if they weren't obese seems a bit like rearranging deck chairs on the Titanic to me, even if they do need rearranging. [1] https://www.drugs.com/news/patient-doctor-disagreements-more-likely-overweight-patients-107762.html https://www.drugs.com/news/patient-doctor-disagreements-more...
deleted 4y ago
[deleted]
superkuh 4y ago
Despite the phrasing of this title there's always been a better alternative and the problems were well known. Paxlovid is better in every way and it was approved for sars-cov-2 first. Molnupiravir should never have been approved for sars-cov-2 caused covid-19 for out patient use. It was never given except in the context of supervised hospital care for other viral diseases. There's an argument that it could've been approved for this limiting situation but out-patient use was and is absurd.
- kec 4y ago
  Paxlovid apparently has interactions with a large number of relatively common medications, Molnupiravir does not (and one would hope it is only being used in cases where paxlovid is unavailable).
- westcort 4y ago
  Not so: Clinical data supporting this EUA are based on data from 1,433 randomized subjects in the Phase 3 MOVe-OUT trial (NCT04575597). MOVe-OUT is a randomized, placebo-controlled, double-blind clinical trial studying LAGEVRIO for the treatment of non-hospitalized patients with mild-to-moderate COVID-19 who are at risk for progressing to severe COVID-19 and/or hospitalization. Eligible subjects were 18 years of age and older and had one or more pre-defined risk factors for disease progression: over 60 years of age, diabetes, obesity (BMI ≥30), chronic kidney disease, serious heart conditions, chronic obstructive pulmonary disease, or active cancer. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=1b0da643-ab23-4a0b-a9ec-a434522446d0 https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?set...
  - superkuh 4y ago
    So. From the updated EUA for paxlovid which includes the date of the original EUA, https://www.fda.gov/media/155049/download https://www.fda.gov/media/155049/download >On December 22, 2021, the FDA issued an EUA for emergency use of PAXLOVID for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients (12 years of age and older weighing at least 40 kg)... And from your linked document, >LAGEVRIO™ (molnupiravir) capsules, for oral use Original EUA Authorized Date: 12/23/2021 Paxlovid was approved 1 day before molnupiravir. Everything I said was true.
loeg 4y ago
> What's the alternative for those who are at high risk Paxlovid, which was approved first and is more effective.
- deleted 4y ago
  [deleted]
qbasic_forever 4y ago
Wear high quality N95 masks around the general public and people you haven't personally trusted to test negative that day.
- mrob 4y ago
  Or better yet, a N100 or equivalent half-face respirator, which will likely be more comfortable because of the soft elastomeric seal, as well as being more effective.

by elhudy 4y ago

What's the alternative for those who are at high risk of being hospitalized or experiencing permanent damage from covid? Until there is a clear alternative, this drug probably isn't going anywhere.

AmericanChopper 4y ago

From the article: > Sarah Otto, an evolutionary biologist at the University of British Columbia in Vancouver, Canada, says the paper is another blow to the continued use of molnupiravir. She notes that a large-scale UK study found that the drug had no effect on hospitalizations or deaths

elhudy 4y ago
I read the article and my point still stands. Put yourself in the shoes of the patient (who largely drives their own care for these situations). You get covid, you go into the dr with a cough and say "dr, this is getting bad, and I'm obese and scared!" The dr goes, "well, we have this drug that was proven to be slightly effective in double blind placebo controlled trials. It has no adverse side-effects. But a large scale study showed it might not actually be effective. Would you like to try that?" The patient, who is probably on medicare or hit their deductible, is going to say yes give me that shit. People have been saying this same thing about the over-prescription of antibiotics for ages but nothing has changed.
- sarchertech 4y ago
  In this case there is a much more effective drug available—-Paxlovid.
  - elhudy 4y ago
    Totally agreed, however... >There are 636 drugs known to interact with Paxlovid (nirmatrelvir/ritonavir), along with 5 disease interactions, and 2 alcohol/food interactions. Of the total drug interactions, 236 are major, 360 are moderate, and 40 are minor. Of these interactions, several are with: statins, blood thinners, hormonal birth controls, and other heart medications. The exact high-risk population who is taking these drugs, have potential interactions with paxlovid. That wipes out a significant portion of the general population from eligibility.
    - sarchertech 4y ago
      636 interactions sounds impressive. But almost any drug that’s been around for a while (like Ritonavir has) will have hundreds of interactions listed. Drug interaction databases aren’t complete nonsense, but you should take them with a huge grain of salt. The vast majority of those interactions won’t prevent a physician from prescribing Paxlovid, and for most of the rest there are either alternatives or patients can lower dosages or stop taking them for the duration of treatment.
      - elhudy 4y ago
        For better or worse, I'm fairly certain statins do prevent drs from prescribing paxlovid on occasion. Happened to a family member. Tons of high risk / older Americans are on statins.
        sarchertech 4y ago
        There are statins that can be taken with Paxlovid. The general recommendations are to either to stop taking them 12 hours before through a few days after treatment or switch temporarily to one of the statins that can be take with Paxlovid.
        elhudy 4y ago
        I agree that in an ideal world, drs would recommend your course of action. I am not debating that statins can be stopped and paxlovid taken, with statins resumed after the disease has run its course. that doesnt change the fact that doctors will still hesitate to prescribe paxlovid if their patient is on statins. This could be for a number of reasons - but consider for a second that up to 55% of seniors are already noncompliant in listening to their drs and taking their medication. When you are asking a patient to stop taking a drug that they have habitually taken for potentially decades, and they have shown hesitancy or inability to comply in the past, maybe prescribing a drug with a potentially serious interaction isnt the best course of action.
        4y ago
- keyanp 4y ago
  Or we disallow its use so it can’t be prescribed and instead the Dr gives them Paxlovid.
  - elhudy 4y ago
    see my below response re: paxlovid and its interactions
- deleted 4y ago
  [deleted]
- brigandish 4y ago
  > I'm obese and scared! Might I say the unsayable with not too scared to lose weight? Perhaps doctors should be ignoring the pride of their patients and telling them, after 3 years, to take their health seriously instead of waiting for the grim reaper to knock on their door? Doctors are also able to prescribe weight loss drugs, surgeries, and generally tell people what they really need to hear so we might ask why the problem persists. Maybe it's because they don't listen to advice they don't want to hear. From [1]: > The researchers found that disagreement between GPs and patients increased with patients' excess weight and was particularly pronounced for advice given by GPs on weight and lifestyle issues. Overweight patients were more likely to disagree with their GP regarding advice given on weight loss (odds ratio, 10.7), advice given on doing more physical activity (odds ratio, 1.9), and nutritional advice (odds ratio, 2.9) compared with patients with a "normal" body mass index. I'm not suggesting doctors be rude, and, as that study points out, if doctors are taking such steps and obese patients ignore them and it harms the relationship then should we not be considering other things to push them? Some people propose sugar taxes and the like but I think that still pushes responsibility away from the main cause of the problem, which is the person. Obese people should pay higher taxes and/or insurance fees that are then mitigated by efforts such as slimming classes, gym attendance etc. Or, we can continue to allow a section of society to risk their own health and mortality while putting enormous strain and cost on the health service and thus risking everyone's health and mortality. Arguing about a drug that most of them wouldn't need if they weren't obese seems a bit like rearranging deck chairs on the Titanic to me, even if they do need rearranging. [1] https://www.drugs.com/news/patient-doctor-disagreements-more-likely-overweight-patients-107762.html https://www.drugs.com/news/patient-doctor-disagreements-more...

deleted 4y ago

[deleted]

superkuh 4y ago

Despite the phrasing of this title there's always been a better alternative and the problems were well known. Paxlovid is better in every way and it was approved for sars-cov-2 first. Molnupiravir should never have been approved for sars-cov-2 caused covid-19 for out patient use. It was never given except in the context of supervised hospital care for other viral diseases. There's an argument that it could've been approved for this limiting situation but out-patient use was and is absurd.

kec 4y ago
Paxlovid apparently has interactions with a large number of relatively common medications, Molnupiravir does not (and one would hope it is only being used in cases where paxlovid is unavailable).
westcort 4y ago
Not so: Clinical data supporting this EUA are based on data from 1,433 randomized subjects in the Phase 3 MOVe-OUT trial (NCT04575597). MOVe-OUT is a randomized, placebo-controlled, double-blind clinical trial studying LAGEVRIO for the treatment of non-hospitalized patients with mild-to-moderate COVID-19 who are at risk for progressing to severe COVID-19 and/or hospitalization. Eligible subjects were 18 years of age and older and had one or more pre-defined risk factors for disease progression: over 60 years of age, diabetes, obesity (BMI ≥30), chronic kidney disease, serious heart conditions, chronic obstructive pulmonary disease, or active cancer. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=1b0da643-ab23-4a0b-a9ec-a434522446d0 https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?set...
- superkuh 4y ago
  So. From the updated EUA for paxlovid which includes the date of the original EUA, https://www.fda.gov/media/155049/download https://www.fda.gov/media/155049/download >On December 22, 2021, the FDA issued an EUA for emergency use of PAXLOVID for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients (12 years of age and older weighing at least 40 kg)... And from your linked document, >LAGEVRIO™ (molnupiravir) capsules, for oral use Original EUA Authorized Date: 12/23/2021 Paxlovid was approved 1 day before molnupiravir. Everything I said was true.

loeg 4y ago

> What's the alternative for those who are at high risk Paxlovid, which was approved first and is more effective.

deleted 4y ago
[deleted]

qbasic_forever 4y ago

Wear high quality N95 masks around the general public and people you haven't personally trusted to test negative that day.

mrob 4y ago
Or better yet, a N100 or equivalent half-face respirator, which will likely be more comfortable because of the soft elastomeric seal, as well as being more effective.