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An oral antiviral pill for Covid speeds recovery in vaccinated but susceptible patients, but does not reduce the likelihood they will need hospital care or die, research suggests.
The UK became the first country in the world to approve molnupiravir for Covid in November 2021, with the pill – which can be taken at home twice a day – being given to patients through the Panoramic (Platform Adaptive Trial of Novel Antivirals for Early Treatment of Covid) program. -19 in the community) trial.
Hope was high after a study at the time suggested the antiviral halved the risk of hospitalization or death in high-risk patients without the vaccine. But shortly after approval, further work, conducted when the delta variant predominated, suggested the drug had less of an effect than first thought.
Research now published in The Lancet found that molnupiravir did not reduce the risk of hospitalization or death in vaccinated, high-risk people exposed to the omicron variant.
Professor Chris Butler of Oxford University and co-principal investigator of the trial said there may still be circumstances in which antivirals may be helpful – for example, to help key staff return to work quickly if systems are under high pressure.
But, he added: “It is a complex political decision that needs to be made in light of the circumstances at the time.”
Adults in the UK were eligible for the trial if they tested positive for Covid by PCR or lateral flow test, were ill in the community and were either aged 50 or over or aged over 18 with a health condition that made them susceptible. were covid.
Between 8 December 2021 and 27 April 2022, the team recruited more than 25,700 eligible participants, of whom 94% received at least three doses of the Covid vaccine.
Half of the participants were randomly allocated to receive usual care, while half were couriered to a five-day course of molnupiravir.
The results, based on a 28-day follow-up period, showed that both groups experienced similar rates of hospitalization or death, such outcomes were recorded for 98 of the 12,525 participants who received usual care and for whom such data were available. 105 of 12,529 participants who were also given molnupiravir.
The team said the low rate reflects the importance of covid jabs. “Vaccination is a very powerful tool to fight this epidemic,” Butler said.
Although participants given molnupiravir reported a median recovery time of nine days compared to 15 days for those receiving usual care alone, further analysis suggested that molnupiravir increased recovery by an average of 4.2 days.
Those given molnupiravir had less contact with their GP, and an earlier, higher rate of sustained recovery while fewer people in this group had the virus after seven days, and had lower viral loads.
Professor Martin Landre, also of Oxford University, but who was not involved in the trial, noted that participants knew whether they were taking antivirals.
“While this knowledge would not influence hospital admissions or death, we have no way of knowing whether it could bias findings on self-reported clinical outcomes,” he said.
The cost-effectiveness of molnupiravir and any effect on prolonged covid remain to be analyzed.
However, Professor Richard Hobbs of the University of Oxford and the Panoramic co-trial lead said a course of antivirals cost several hundred pounds.
“So its deployment depends on factors like how much the country is likely to benefit from an average four-day improvement in symptoms,” he said.
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