Several treatments are available for the management of people at high risk of a severe form of COVID-19, but the emergence of new variants is impacting their effectiveness. The National Agency for the Safety of Medicines and Health Products (ANSM) has just taken stock of the use of these treatments.
What treatments can still be used?
As a curative treatment, for non-oxygen-requiring patients at high risk of progression to a severe form of COVID-19:
- Paxlovid® (nirmatrelvir / ritonavir) in first intention;
- Veklury® (remdesivir) as second-line treatment in the event of a formal contraindication to Paxlovid®and in the absence of contraindications, in particular renal.
Paxlovid® is an orally administered antiviral. It has a European marketing authorization and is reimbursed in town. It should be administered as soon as possible after the diagnosis of COVID-19 and at most within five days of the onset of symptoms. For adult patients who could benefit from it, a conditional prescription for a maximum of 3 months can be established in order to facilitate access to treatment in town pharmacies. It is important to remember that there is a significant risk of drug interactions with Paxlovid® (consult the summary of product characteristics and the website of the French Society of Pharmacology and Therapeutics).
Veklury® is an antiviral administered by intravenous infusion over a treatment period of three days. It has a European Marketing Authorization and must be started as soon as possible after the diagnosis of COVID-19, within 7 days of the onset of symptoms. Patients should be closely monitored during and after administration (risk of infusion-related reactions and/or hypersensitivity). In addition, in view of potential renal toxicity, renal function should be monitored before and during treatment.
Which treatments should no longer be used?
Three monoclonal antibodies specifically targeting the Spike protein of SARS-CoV-2 have European MA: Evusheld® (tixagévimab/cilgavimab), Ronapreve® (casirivimab/imdevimab) et Xevudy® (sotrovimab). However, the variants currently circulating in France carry mutations in the Spike protein which significantly alter the activity of these treatments. Thus, Evusheld® and Ronapréve® are no longer recommended in the current epidemic context, neither in curative treatment nor in pre-exposure prophylaxis.
As for Xevudy®it is not indicated for pre-exposure prophylaxis and its place in curative treatment, in the current context, remains to be determined: an evaluation of its antiviral activity on the dominant sub-lineages is in progress.