剛剛幫患者開 paxlovid. 印象中這個藥物曾過期展延. 所以又查詢一下.
這篇是去年 112-07-31 的文章
重點.
1. 治療對象. 非重症但高風險
2. 預防性使用. 不是等到症狀嚴重才用
3. paxlovid 優於 molnupiravir
印象中降低重症風險比例. paxlovid 可降低 70%. 而 molnupiravir 可降 30%
疾管署澄清莫納皮拉韋(Molnupiravir)用藥條件調整，並非「大批倍拉維(Paxlovid)即將過期」，係為提供COVID-19確診個案更良好的醫療照護，降低重症及死亡
Paxlovid在預防高風險確診個案的效能優於莫納皮拉韋(Molnupiravir)，且治療可能引發傷害的疑慮少於Molnupiravir，因此強烈建議(strong recommendation)以Paxlovid為治療非重症但有高住院風險之COVID-19確診個案的優選藥物。
2022-05-21 21:39 xuite 無法登入. 可能網站當了吧.
資料來源 GoodRx
paxlovid 與 molnupiravir 比較
這兩種藥物都是吃五天.
目前治療指引將 paxlovid 列為優先選擇
paxlovid 降低症症風險效益比較好, 價格稍微便宜 ($530 VS $700)
但paxlovid缺點是與其他藥物交互作用多
高風險個案, 通常都有一些慢性疾病
因此用藥之前須先篩選. 如果病患長期服用的藥物有衝突
需考慮改藥, 例如降膽固醇藥物 statin 類暫時停用
另外, 由於 paxlovid 的效果可能會持續三天.
經過五天治療, 某些慢性病藥物還要多停藥三天, 總共八天, 以減少藥物交互作用
Paxlovid 用於慢性腎病患者. eGFR 30-60 要減量. eGFR < 30 則不建議使用
因為paxlovid 是經腎臟代謝. 腎衰竭患者可能在體內會累積過高的藥物濃度
而增加副作用機率.
How effective are Paxlovid and molnupiravir for treating COVID-19?
Probably the most notable difference between Paxlovid and molnupiravir is how effective they are.
In clinical trials, Paxlovid was nearly 90% effective at preventing hospital stays or death due to COVID-19 in high-risk people. Ongoing clinical trials suggest Paxlovid is about 70% effective in people with a standard risk of severe illness.
On the other hand, molnupiravir lowered the risk of COVID-19 hospital stays or death by about 30% in high-risk people. This difference in effectiveness may be one of the reasons the FDA suggests using molnupiravir only if other treatments aren’t available.
It’s important to note that these levels of effectiveness were recorded when study participants started Paxlovid or molnupiravir within 5 days of first feeling symptoms. The medications’ effectiveness is lower if the medications are started after this timeframe.
What is the Paxlovid rebound effect?
In late April 2022, some reports emerged of people experiencing a return (or rebound) of their COVID-19 symptoms after finishing their Paxlovid prescription.
For some people, the symptoms are mild. But others find their rebound symptoms are worse than their original symptoms. Some people are also reporting they’re testing positive again after testing negative at the end of their 5-day Paxlovid treatment.
Typically, Paxlovid helps lower the amount of COVID-19 virus in your body. This gives your immune system a chance to catch up and finish fighting off the remainder of the virus. But it seems that some people’s immune systems aren’t doing that, which is something experts don’t fully understand, yet.
Clinical trials suggest this is rare. In a key study, only 2% of people who took Paxlovid experienced a rebound effect. This was similar to the 1.5% of those who experienced a rebound effect while taking a placebo (a pill with no medication in it). Researchers are going to continue to monitor these findings.
Pfizer has recommended taking another 5-day course of Paxlovid if this happens. However, the FDA doesn’t agree with this approach. Paxlovid is still only recommended to be used for 5 days at a time.
As more information about the Paxlovid rebound effect is discovered, we’ll be sure to update you. Check out our COVID-19 treatments article for the most up-to-date information on all available treatments.
下面這篇是刊登在 NEJM 的研究, 直接看 result 和 conclusion
對於有重症風險或沒打疫苗的個案. 早期使用可減少住院或死亡率
Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients
February 10, 2022
RESULTS
A total of 1433 participants underwent randomization; 716 were assigned to receive molnupiravir and 717 to receive placebo. With the exception of an imbalance in sex, baseline characteristics were similar in the two groups. The superiority of molnupiravir was demonstrated at the interim analysis; the risk of hospitalization for any cause or death through day 29 was lower with molnupiravir (28 of 385 participants [7.3%]) than with placebo (53 of 377 [14.1%]) (difference, −6.8 percentage points; 95% confidence interval [CI], −11.3 to −2.4; P=0.001). In the analysis of all participants who had undergone randomization, the percentage of participants who were hospitalized or died through day 29 was lower in the molnupiravir group than in the placebo group (6.8% [48 of 709] vs. 9.7% [68 of 699]; difference, −3.0 percentage points; 95% CI, −5.9 to −0.1). Results of subgroup analyses were largely consistent with these overall results; in some subgroups, such as patients with evidence of previous SARS-CoV-2 infection, those with low baseline viral load, and those with diabetes, the point estimate for the difference favored placebo. One death was reported in the molnupiravir group and 9 were reported in the placebo group through day 29. Adverse events were reported in 216 of 710 participants (30.4%) in the molnupiravir group and 231 of 701 (33.0%) in the placebo group.
CONCLUSIONS
Early treatment with molnupiravir reduced the risk of hospitalization or death in at-risk, unvaccinated adults with Covid-19. (Funded by Merck Sharp and Dohme; MOVe-OUT ClinicalTrials.gov number,
下面圖片來自 GoodRx 網站
疾管署澄清莫納皮拉韋(Molnupiravir)用藥條件調整，並非「大批倍拉維(Paxlovid)即將過期」，係為提供COVID-19確診個案更良好的醫療照護，降低重症及死亡
Paxlovid在預防高風險確診個案的效能優於莫納皮拉韋(Molnupiravir)，且治療可能引發傷害的疑慮少於Molnupiravir，因此強烈建議(strong recommendation)以Paxlovid為治療非重症但有高住院風險之COVID-19確診個案的優選藥物。
2022-05-21 21:39 xuite 無法登入. 可能網站當了吧.
資料來源 GoodRx
paxlovid 與 molnupiravir 比較
這兩種藥物都是吃五天.
目前治療指引將 paxlovid 列為優先選擇
paxlovid 降低症症風險效益比較好, 價格稍微便宜 ($530 VS $700)
但paxlovid缺點是與其他藥物交互作用多
高風險個案, 通常都有一些慢性疾病
因此用藥之前須先篩選. 如果病患長期服用的藥物有衝突
需考慮改藥, 例如降膽固醇藥物 statin 類暫時停用
另外, 由於 paxlovid 的效果可能會持續三天.
經過五天治療, 某些慢性病藥物還要多停藥三天, 總共八天, 以減少藥物交互作用
Paxlovid 用於慢性腎病患者. eGFR 30-60 要減量. eGFR < 30 則不建議使用
因為paxlovid 是經腎臟代謝. 腎衰竭患者可能在體內會累積過高的藥物濃度
而增加副作用機率.
How effective are Paxlovid and molnupiravir for treating COVID-19?
Probably the most notable difference between Paxlovid and molnupiravir is how effective they are.
In clinical trials, Paxlovid was nearly 90% effective at preventing hospital stays or death due to COVID-19 in high-risk people. Ongoing clinical trials suggest Paxlovid is about 70% effective in people with a standard risk of severe illness.
On the other hand, molnupiravir lowered the risk of COVID-19 hospital stays or death by about 30% in high-risk people. This difference in effectiveness may be one of the reasons the FDA suggests using molnupiravir only if other treatments aren’t available.
It’s important to note that these levels of effectiveness were recorded when study participants started Paxlovid or molnupiravir within 5 days of first feeling symptoms. The medications’ effectiveness is lower if the medications are started after this timeframe.
What is the Paxlovid rebound effect?
In late April 2022, some reports emerged of people experiencing a return (or rebound) of their COVID-19 symptoms after finishing their Paxlovid prescription.
For some people, the symptoms are mild. But others find their rebound symptoms are worse than their original symptoms. Some people are also reporting they’re testing positive again after testing negative at the end of their 5-day Paxlovid treatment.
Typically, Paxlovid helps lower the amount of COVID-19 virus in your body. This gives your immune system a chance to catch up and finish fighting off the remainder of the virus. But it seems that some people’s immune systems aren’t doing that, which is something experts don’t fully understand, yet.
Clinical trials suggest this is rare. In a key study, only 2% of people who took Paxlovid experienced a rebound effect. This was similar to the 1.5% of those who experienced a rebound effect while taking a placebo (a pill with no medication in it). Researchers are going to continue to monitor these findings.
Pfizer has recommended taking another 5-day course of Paxlovid if this happens. However, the FDA doesn’t agree with this approach. Paxlovid is still only recommended to be used for 5 days at a time.
As more information about the Paxlovid rebound effect is discovered, we’ll be sure to update you. Check out our COVID-19 treatments article for the most up-to-date information on all available treatments.
下面這篇是刊登在 NEJM 的研究, 直接看 result 和 conclusion
對於有重症風險或沒打疫苗的個案. 早期使用可減少住院或死亡率
Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients
February 10, 2022
RESULTS
A total of 1433 participants underwent randomization; 716 were assigned to receive molnupiravir and 717 to receive placebo. With the exception of an imbalance in sex, baseline characteristics were similar in the two groups. The superiority of molnupiravir was demonstrated at the interim analysis; the risk of hospitalization for any cause or death through day 29 was lower with molnupiravir (28 of 385 participants [7.3%]) than with placebo (53 of 377 [14.1%]) (difference, −6.8 percentage points; 95% confidence interval [CI], −11.3 to −2.4; P=0.001). In the analysis of all participants who had undergone randomization, the percentage of participants who were hospitalized or died through day 29 was lower in the molnupiravir group than in the placebo group (6.8% [48 of 709] vs. 9.7% [68 of 699]; difference, −3.0 percentage points; 95% CI, −5.9 to −0.1). Results of subgroup analyses were largely consistent with these overall results; in some subgroups, such as patients with evidence of previous SARS-CoV-2 infection, those with low baseline viral load, and those with diabetes, the point estimate for the difference favored placebo. One death was reported in the molnupiravir group and 9 were reported in the placebo group through day 29. Adverse events were reported in 216 of 710 participants (30.4%) in the molnupiravir group and 231 of 701 (33.0%) in the placebo group.
CONCLUSIONS
Early treatment with molnupiravir reduced the risk of hospitalization or death in at-risk, unvaccinated adults with Covid-19. (Funded by Merck Sharp and Dohme; MOVe-OUT ClinicalTrials.gov number,
下面圖片來自 GoodRx 網站
