Australia’s real-world experience is that the two COVID-19 oral antiviral treatments approved for local use are both highly effective at protecting older Australians – a key at-risk population group – from hospitalisation and death.
Although vaccination remains the best form of protection against COVID-19, the two treatments – Lagevrio® (molnupiravir) and Paxlovid® (nirmatrelvir and ritonavir) – have been an additional gamechanger in preventing severe illness and death among those most at risk.
The real-world findings are based on an analysis of Victorian data involving more than 27,000 people aged 70 years and over. This analysis found that the use of COVID-19 oral antivirals led to clear reductions in the risks of hospitalisation and death, compared to instances where treatments were not used.
Given people aged 70 and over are eligible for the treatments in every state and territory, the conclusions are applicable nationwide.
The experience in Australia is more positive than the findings contained in PANORAMIC – a UK trial of molnupiravir.
It needs to be stressed the participants in the UK study were generally younger than those eligible for the treatments in Australia – and many had no risk factors that would make them more likely to become seriously unwell.
A large proportion of the people enrolled in the UK study would not be eligible for the treatments in Australia and these research findings cannot be directly applied to most people receiving treatments in Australia.
Australia’s Pharmaceutical Benefits Advisory Committee (PBAC) recently noted that in two-thirds of the instances in which molnupiravir had been used through its listing on the Pharmaceutical Benefits Scheme, patients were aged 70 years or over. In the PANORAMIC study, only 6 per cent of participants were aged 75 years or older.
PBAC also noted patients at highest risk of progression to severe disease in the UK were not the target population for enrolment in the PANORAMIC trial. In Australia, these are the people who have specifically been made eligible for these treatments.
It further noted the Victorian data, combined with the results of observational studies in Israel and Hong Kong, demonstrated a benefit of molnupiravir over no treatment in patients at high risk of progression to severe disease.
PBAC concluded that while nirmatrelvir and ritonavir may be preferred for many patients at high risk of becoming severely unwell, in many common clinical circumstances, this treatment is contraindicated or unsuitable for use, especially in people with some underlying conditions, such as severe kidney or liver disease. It also has a number of drug interactions with commonly used medicines.
In such circumstances, molnupiravir remains a suitable option.
It is very important Australians, particularly older Australians and those who are immunocompromised, talk to their doctors about their eligibility for COVID-19 antiviral treatments – and if eligible, make sure they can access and start their treatments as quickly as possible after a positive COVID-19 test result.