People at high risk of developing severe disease after testing positive for COVID-19 will now have access to another antiviral, through a large UK study

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A second antiviral has been added to a large UK study investigating home treatments for people at high risk of developing severe disease after testing positive for COVID-19.

Pfizer’s Paxlovid (nirmatrelvir/ritonavir)—an oral use combination of nirmatrelvir and ritonavir—has been used to treat 6000 patients since February, including those who are immunocompromised, but its addition to the Platform Adaptive trial of NOvel antiviRals for eArly treatMent of COVID-19 in the Community  (PANORAMIC) trial will allow investigation of its effectiveness now that most of the population has been vaccinated against COVID-19.

Launched in December 2021, the PANORAMIC study, run by the Nuffield Department of Primary Care Health Sciences, has so far recruited over 20,000 patients to help generate data for the antiviral molnupiravir (Lagevrio, Merck Sharp & Dohme). The introduction of Paxlovid will allow a further 17,500 people to enrol, the Department of Health and Social Care (DHSC) said.

An interim analysis of Paxlovid demonstrated an 89% reduction in COVID-19-related hospitalisation or death from any cause compared to placebo in patients treated within 3 days of symptom onset, Pfizer claimed in a press release  last November.

An ‘exciting addition’

Professor Paul Little, from the University of Southampton, and Co-Chief Investigator, said:‘The PANORAMIC trial is one of the most ambitious ever undertaken in the community worldwide. The inclusion of Paxlovid in the trial is an exciting addition that will provide vital information about treatments to help the most vulnerable people in the ongoing fight against COVID.’

The study is open to adults over the age of 50 years or those aged 18–49 years with an underlying health condition that can increase the risk of developing severe COVID-19, who have received a positive test result, and who are experiencing symptoms that started in the previous 5 days.

Recruitment for the Paxlovid arm of the trial will only be available in England initially via GP hubs. The DHSC said it was working with counterparts in the devolved nations to develop plans for how to enlarge the enrolment base.

Registration for the PANORAMIC study will be paused over the Easter period, reopening on 18 April. A notice on the study website today said it was ‘experiencing an extraordinarily large volume of registrations’, and was only able to recruit 450 people each week day.

The PANORAMIC study is supported by the National Institute for Health and Care Research (NIHR). Professor Nick Lemoine of the NIHR described today’s development as ‘exciting’.

He said: ‘While smaller-scale studies have already shown this new antiviral treatment to be highly effective against COVID in the early stages of infection, additional evidence from much larger cohorts is needed to enable clinicians and health services to make best use of these exciting new treatments.’

The UK had procured 4.98 million courses of antivirals in total, the DHSC said.

From 28 March, Paxlovid has also been used in the RECOVERY trial from Oxford University, a randomised study testing COVID-19 treatments in hospitals throughout Britain.

This article originally appeared on Medscape, part of the Medscape Professional Network.


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