Paxlovid: The introduction of a novel anti-SARS-Cov-2 therapy on the Dutch antiviral market

Abstract

In January 2020, a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) was discovered in Wuhan, China after pneumonia outbreak occurred. The World Health Organization (WHO) later defined as Corona Virus Disease 19 (COVID-19) and officially declared COVID-19 a pandemic in March 2020. Since then, over 470 million cases have been confirmed and over 6 million people worldwide have passed away due to COVID-19. As a response to the pandemic, Pfizer has developed a covid vaccine and is marketing their novel anti-SARS-Cov-2 main protease inhibitor (PI) in 2022. Paxlovid achieves its antiviral effect by inhibiting an essential protease in the viral replication process. The 3CL protease digests polyprotein to produce a set of proteins that are vital for the virus replication and transcription. By inhibition of the SARS-Cov-2 3CL protease, the virus is unable to proliferate, and the infection is halted. This research aims to describe the COVID-19 pandemic from multiple perspectives, to illustrate the journey covid patients follow from symptoms development to treatment and recovery, to identify questions healthcare professionals have surrounding novel antivirals, assess where and who supervises the prescription of Paxlovid, and what role Paxlovid can play in the future of this pandemic. This research includes historical comparison to the HIV epidemic, an overview of the novel SARS-Cov-2 pathogen, a summary of the current treatment protocols for COVID-19 patients, the effects of the vaccines on the progression on the pandemic, the Paxlovid product profile, and the opinion of healthcare professionals in covid care. A new patient journey will be illustrated to show which parties are involved in the implementation and prescription of Paxlovid. In addition, the unmet need and the role of Paxlovid will be assessed based on the current pandemic climate and the view of healthcare professionals (HCPs) in the field. At present, treatment initiation happens only when patients are hospitalized, which rarely happens within five days since symptoms onset. In order to introduce Paxlovid in the patient journey, the initiation of treatment has to move to primary care, overseen by the general physician. However, the general physicians do not possess the expertise that pulmonologists and infectious disease specialists do. These experts should transition their role from overseeing the treatment to advising the general physicians in assessment of eligibility for the therapy and its prescription, based on guidelines provided by SWAB and other medical professional organizations. The role Paxlovid could play for covid patients largely depends on the danger the pathogen poses at present times, which is relatively low. HCPs indicated that there is a small patient population at the moment and thus unmet need that antivirals could fulfill is small as well. However, the unmet need those individuals with a high risk of severe disease progression experience might differ from the estimation that HCPs. Healthcare should be accessible and inclusive, therefore highlighting the importance of Paxlovid to the high-risk patient community. To ensure adequate administration of this antiviral therapy within the first five days since symptom onset, the general physician takes on a bigger role than just the prescribing party and will be the central point of oversight in the patient journey. The medical experts, pulmonologists and IDSs, will take on an informative and supportive role for the general physician. Furthermore, policy makers, healthcare organizations and regulatory bodies need to provide HCPs with clear and concise information and guidelines on the antivirals. When these measures are in place, Paxlovid can help protect high-risk patients from severe covid symptoms and hospitalization.