english.prescrire.org > Annual Prescrire Awards > The Prescrire Awards for 2022 > The Prescrire Drug Awards for 2022 > 2022 Drug Awards > Paxlovid° (nirmatrelvir + ritonavir): on the Honours List at the 2022 Prescrire Drug Awards

The Prescrire Awards for 2022

The Prescrire Drug Awards for 2022

The Prescrire Drug Awards for 2022
Honours List Paxlovid° (nirmatrelvir + ritonavir)

Le Palmarès des Médicaments Drugs included on the Honours List constitute a clear advance for some patients compared with existing therapeutic options, albeit with limitations.


One drug examined in 2022 earned a place on the Honours List:

• PAXLOVID° (nirmatrelvir + ritonavir) - Pfizer

Nirmatrelvir + ritonavir (Paxlovid°) in covid-19: fewer complications in symptomatic patients at risk of developing severe disease.

A 5-day course of the combination of nirmatrelvir (a Sars-CoV-2 protease inhibitor) + ritonavir (an inhibitor of the cytochrome P450 isoenzyme CYP3A4) was compared with placebo in a double-blind randomised trial in 2246 adults with covid-19 who had had symptoms for 5 days at most, but showed no signs of severe disease. Most were infected with the Sars-CoV-2 Delta variant, and they all had at least one risk factor for developing severe covid-19 (mainly obesity, hypertension or diabetes). Only 22% of them were aged 60 years or over. None of the patients had been vaccinated against covid-19, but half of them had anti-Sars-CoV-2 antibodies, indicating prior infection with this virus. In the month following the start of treatment, 0.8% of patients in the nirmatrelvir + ritonavir group were hospitalised, versus 6% in the placebo group (p<0.0001).

Epidemiological data from a later period suggest that nirmatrelvir + ritonavir reduces the risk of hospitalisation or death due to covid-19 in adults when the Omicron variant is predominant, including in those vaccinated against covid-19. These data provide lower-quality evidence than the results of the single trial available, but they are consistent with the trial data, which is not surprising given that the mechanism of action of this combination is independent of the spike protein mutations that characterise the different Sars-CoV-2 variants. Very little is known about nirmatrelvir's adverse effects. Treatment with nirmatrelvir + ritonavir is difficult to manage due to the risk of major drug interactions and the risk of overdose in patients with renal impairment.

The combination of nirmatrelvir + ritonavir was developed sufficiently rapidly to reduce the number of hospitalisations and limit the burden placed on hospitals by covid-19, especially when infection rates were at their highest, thus earning it a place on the 2022 Honours List.

A Pilule d'Or (Golden Pill) is granted to drugs that represent a major therapeutic advance in a field in which no treatment was previously available. Drugs included on the Honours List constitute a clear advance for some patients compared with existing therapeutic options, albeit with limitations. Drugs deemed "Noteworthy" provide a modest improvement in patient care.
SEE: > About the Prescrire Drug Awards for 2022

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> The Prescrire Drug Awards for 2022


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 FREE  "The Prescrire Awards for 2022" Prescrire International 2023; 32 (246): 80-81. (pdf, free)

 

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©Prescrire March 2023
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