BarcelonaShortly after co-designing one of the most successful vaccines of this century, multinational company Pfizer introduced the world to a pill that was supposed to protect the elderly and seriously ill from hospitalization and death if they contracted the coronavirus: baxlovid. This antiviral slows the progression of infection and prevents death in 90% of cases if taken early. But in practice, baxlovid has died a success: it is a difficult drug to prescribe, and the stockpile that European countries, such as Spain, had rushed to amass, is beginning to run out. In 2022, the country purchased 344,000 doses, of which Catalonia received 56,091 doses. According to the ARA, only 5,600 Catalan patients have received antivirals since then, and thus, only 10% of the available units have been prescribed and dispensed.
The World Health Organization (WHO) has recommended the use of baxlovid, arguing that it is “the best treatment tool against the virus for patients at high risk of complications.” In addition, it has the advantage that it can be taken comfortably at home when you have symptoms, without the need for hospitalization. Both your primary care doctor and a hospital emergency physician can prescribe it for five days. In total, the treatment consists of 30 pills taken every 12 hours, meaning that the person takes six pills per day. In the face of encouraging results for the drug baxlovid, and before the European Medicines Agency gave the green light, the European Union and the United Kingdom obtained thousands of doses to prepare for an emerging microbial variant that threatens to destabilize the epidemic calm.
However, according to an analysis by British consultancy Airfinity, no EU country has used the bulk of baxlovid doses purchased, and Spain will be the country that has used the least: it has issued only 130,000 doses. The remaining 214,000 have expired in pharmacy cabinets, and according to the same analysis, this means in economic terms a loss of 160 million euros. The same study found that the UK would be the European country with the highest number of pills in poor condition, with more than a million expired doses, and losses amounting to €638 million. In the EU and UK combined, expired dose data provided by Airfinity's analysis rises to 1.5 million, but Airfinity expects that number to double (3.1 million) next month.
In the case of Spain, the Executive allocated an exceptional allocation of €253 million for the purchase of 344,000 treatments in February 2022. The Ministry of Health, after carrying out a central procurement process, distributed the doses to the autonomous communities according to population criteria; That is, areas with more people with risk factors received more. Catalonia received 56,091 treatments, 16% of the total, throughout 2022: 8,191 first batches arrived in March, 14,476 in June, 16,384 in September and 17,040 in October. However, as of July 2022, only 558 Catalans had received antivirals. Nearly two years later, the number had risen to 5,600. The remaining 50,000 doses have never been used and will expire at the end of January.
the reasons
If baxlovid was a good, effective drug and there were enough stocks of it, why wasn't it used? The Ministry of Health cites two reasons to justify not releasing 90% of the doses. On the one hand, he points out that it is a “complex” drug to prescribe because it “presents multiple clinical contraindications and interactions with other drugs.” This necessitates a highly individualized review of candidates' clinical histories and medication plans before prescribing the drug. In contrast, Sloat points out the small margin that patients and specialists must have to start treatment. “The technical data sheet states that treatment should be started within the first five days of the onset of symptoms, and often, by the time the patient consults due to clinical deterioration, this time has already passed,” the council says.
As the ARA explained in 2022, this treatment may cause greater complications than it attempts to resolve among some potential recipients. Candidates to receive baxlovid have a weakened immune system. This group includes cancer patients, organ transplant recipients, those on dialysis, and people with HIV, cystic fibrosis, or Down syndrome who are over 40 years of age. It is also indicated for people over 80 years of age who have never been vaccinated against coronavirus and for people 65 years of age or older who have also not been vaccinated and have kidney, liver, nervous, pulmonary, or cardiovascular disease, diabetes, or Obesity.
Often, this patient is already taking several medications due to his advanced age or due to diseases and clinical history, and these basic treatments must be discontinued so that these pills do not lead to increased drug concentrations in the blood. While some medications are not life-threatening and can be stopped – such as anti-inflammatories or simvastatin for cholesterol – others such as antidepressants, anticoagulants and immunosuppressants require very careful medical evaluation before they can be temporarily removed.
Baxlovid is an antiviral based on two types of drugs: nermatrelivir, which prevents a key enzyme of the virus from replicating and infecting cells, and ritonavir, which was previously used to treat HIV and now works to enhance the antiviral effect. It is in this second drug that the problem of incompatibility lies: the mechanism it uses for metabolism is a receptor in the liver that is also used by many anticoagulants, benzodiazepines (diazepam), cholesterol inhibitors (simvastatin) or immunosuppressants for transplanted organs (eg cyclosporine).
However, from February, baxlovid is planned to be part of the medicines funded by Social Security, health sources explained to the ARA. “Therefore, treatment will remain available,” they say from Salut.
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