U.S. Doctors seek more information on Paxlovid prescribing amid Covid-19 rebound concerns

Doctors are clamoring for more clarity on Paxlovid prescribing amid Covid-19 rebound concerns “I think the sense of likely risk-benefit has changed over time,” said Walid Gellad, an internal medicine physician at the University of Pittsburgh. Megan Thielking STAT

Six months after regulators issued an emergency use authorization for Paxlovid, physicians say they still have significant questions about prescribing guidelines for the leading treatment for high-risk Covid patients.

STAT spoke with providers who said they and their colleagues aren’t on the same page about when to prescribe Paxlovid or the criteria that separates those who need it from those who do not. They also said it is unclear whether they can give a second course when patients test positive again after taking Paxlovid, a phenomenon known as a rebound. And nearly all the experts who spoke with STAT said that they are clamoring for more data on rebounds, which is complicating and sometimes changing their calculus about when to give the drug.

“There is a real dearth of evidence right now out there, and obviously there’s a lot of confusion,” said Jonathan Li, a physician at Brigham and Women’s Hospital and virology researcher at Harvard Medical School who is also a member of the Covid-19 Treatment Guidelines Panel. “And even amongst people who are immersed in the literature, and who are infectious disease experts, you’ll see actually a fairly wide range in opinions.”

The pool of people who can prescribe Paxlovid is now even broader — on Wednesday, the Food and Drug Administration began allowing pharmacists to prescribe the drug, which was shown to reduce the risk of hospitalization and death by 89% in an early study of unvaccinated patients. The FDA says Paxlovid — a combination of two drugs taken twice a day for five days — should be prescribed within five days of symptom onset to people 12 and older who have tested positive and are “at high risk for progression to severe Covid-19.” Technically, that includes everyone from people who have asthma or obesity to people who are over age 65.

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