Local doctors cautiously optimistic about potential pill to treat covid-19
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Local doctors said a pill to treat covid-19 could help keep patients healthy and ease the burden on overstrained hospitals, though they’re eyeing the drug with cautious optimism while awaiting final data.
Merck & Co. on Friday announced its experimental pill cut hospitalizations and deaths in half for people recently infected with the virus.
The company said it would soon ask health officials in the U.S. and worldwide to authorize the use of their pill, called molnupiravir.
While experts viewed the potential treatment as one that could provide easy and accessible treatment and keep people out of overcrowded hospitals, final data has not yet been released from the study and there are still several unknowns.
It’s best to take Merck’s drug trial “with a grain of salt” for now, said Mike Sekhon, director of pharmacy health at Excela Health.
Merck’s preliminary results, he noted, are based on a study of fewer than 800 people.
It’s also unclear exactly when the pill could be available, though it could be within a matter of weeks if the Food and Drug Administration (FDA) determines the drug offers a significant benefit and pushes it through an approval process quickly, Sekhon said.
If the drug is, in fact, as effective as Merck’s early results indicate, the news is “promising and exciting,” said Dr. Ryan Bariola, an infectious disease physician at UPMC and Pitt School of Medicine, who is one of the leads on UPMC’s monoclonal antibody effort.
“Any time you have a pill that somebody can easily take, provided it works, that’s always better than having to go to the hospital,” he said. “Our hope all along has been to get to the point where we have an oral drug.”
Monoclonal antibody treatment, which has been touted as a promising treatment for the virus, has proven to be effective — but it requires patients to go to an infusion center for the intravenous treatment.
A pill that people could take at home, Bariola said, would likely be easier for some patients. Plus, with a nationwide shortage of health care workers, having patients able to take pills at home themselves rather than require a nurse to administer an IV could help alleviate the burden on overstretched hospitals.
It’s too soon to say whether the pill could also work in conjunction with monoclonal antibody treatments, or which treatment would be more effective for which patients, Bariola said.
“The biggest aspect is just keeping people healthy so they don’t wind up in our ICUs critically sick,” he said.
There has been a need for an easy, effective oral treatment, particularly in underserved communities and parts of the world where scaling up intravenous antibody treatments isn’t feasible, said Dr. Thomas Walsh, an infectious disease specialist and medical director of the Allegheny Health Network Antimicrobial Stewardship Program.
“Every other therapeutic we’ve had has a niche role in small subsets of patients,” he said. “What we’ve really lacked is good outpatient therapies to prevent people from progressing to where they need hospitalization.”
Early data from Merck is “encouraging,” he said, and seems to indicate this drug could be used to treat outpatients with mild to moderate symptoms without requiring the space and staff of an infusion center. Plus, oral pills tend to be easier to mass produce and deliver, he said.
“(Data) show that the potential benefit to reduce hospitalizations is on a scale or potentially even larger than we have with the monoclonal antibodies, with a therapy that’s much easier to use in the outpatient space,” he said.
Merck has said it could ship about 100 million courses of the therapy by the end of the year. Each course consists of two pills per day for five days.
The federal government has already placed orders for the medication in anticipation of its approval.
Most products that are granted the FDA’s emergency use authorization will have an “allocation process for distributors until supply is robust,” Sekhon said. That would likely include offering an initial, limited supply of the drug to individuals who meet a certain set of criteria, like having been diagnosed with co-morbidities that put them at an increased risk of severe illness from the disease.
In clinical trials, Bariola said, the drug was only tested in patients who were at high risk, had mild symptoms and had began presenting symptoms within five days of starting the treatment regimen.
“Ultimately, I would suspect it’s a pill like any other pill-based medications that pharmacies could potentially carry,” Bariola said.
Other oral treatments for the virus are also being studied, he said, and it’s possible there could be multiple treatment options for the virus in the coming months and years.
Eventually, drugs like this one could be used to help covid-19 patients in the same way Tamiflu helps those with influenza, Walsh said. It doesn’t have to be a perfect drug, but if it helps ward off the most serious symptoms in at least some patients, it could help curb the effects of the pandemic.
“Having an easily scalable oral medication during surges to prevent overutilization of hospitals is huge,” he said.
But, he warned, initial FDA authorization of such drugs may be limited to certain subsets of patients, and Merck has yet to release safety data that would tell doctors who may be at risk of adverse reactions from the medicine.
Side effects from the drug are also still unknown, he said.
While current treatments seem promising and others are on the horizon, Bariola said, the ultimate goal is to stop infection altogether.
“It’s not a cure-all,” he said of the drug. “Prevention always beats treatment no matter how great any treatment is. Vaccinations are still our key.”
For unvaccinated people who do contract the virus — or for those who get a breakthrough case — it’s best to seek testing and treatment as soon as possible, Bariola said.
“Whether it’s monoclonal (antibodies) or this oral option or whatever comes down the road next, all of them work best earlier,” he said. “So if you start feeling sick, get tested and seek out care. Don’t delay.”