India added 2,151 COVID-19 cases on March 29, the most in a single day in five months, while active cases in the country rose to 11,903, according to data released by the Union health ministry.
The cases are being recorded in Delhi, Maharashtra, Karnataka, Tamil Nadu, Gujarat, Kerala and Telangana. Higher test positivity rates have also been reported in many states and districts.
Yet, Paxlovid, the orally administered drug developed by Pfizer that prevents severe outcomes of SARS‑CoV‑2 infection, has remained a minor player in India so far.
Several generic versions of the drug are available in India, including those made by Hetero (Nirmacom), Zenara (Paxgen), and Azistra (Paxista) but they are said to be available mainly in hospital pharmacies in certain cities.
Swapneil Parikh, an internist and clinical researcher in Mumbai, said it’s high time their availability is widened so that those who need it can get it easily.
Many positives
Paxlovid consists of nirmatrelvir, which stops the virus from replicating, and ritonavir, which slows down nirmatrelvir’s breakdown to help it remain in the body for a longer period at higher concentrations. Three tablets (two nirmatrelvir tablets and one ritonavir tablet) are taken together orally twice daily for five days.
The drug has shown an 89 percent reduction in the risk of hospitalisation and death in unvaccinated people and benefits even those who are vaccinated. It has been shown to be effective against Omicron variants.
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The medication is suggested for high-risk people aged 12 and above, with a body weight of at least 40 kg.
People with high risk of severe COVID-19 are those with underlying conditions such as cancer, diabetes, or obesity, and those who are 65 or older (more than 81 percent of COVID-19 deaths occur in this group).
The more underlying medical conditions a person has, the greater the risk of developing a severe case of COVID-19, the US Centers for Disease Control and Prevention said.
That’s why physicians and infectious diseases experts including Anupam Singh, based in Ghaziabad, say it would be useful to have Paxlovid easily available. However, he has not used it for any of his patients due to lack of availability.
Parikh said some generic versions of the drug are available in pharmacies of two major private hospitals in Mumbai and they may be inaccessible to patients who may be able to arrest the progression to a severe form of the disease if started on the course early.
“As the drug is contraindicated for hospitalised COVID-19 patients, it makes little sense to supply the drug to pharmacies inside hospitals,” he said.
Not in treatment protocol
Paxlovid is not included in India’s COVID-19 treatment protocol, which may be why the drug is not given to many patients.
Hetero and Zenara did not respond to Moneycontrol’s queries on the supply of the drug. However, executives in these companies said limited quantities of the drug are supplied to select hospitals.
Devashish Desai, an infectious diseases consultant with Ruby Hall Clinic, said it is unlikely India will require access to large stocks of this drug.
“Ever since the Omicron variant of SARS‑CoV‑2 and its sub-lineages became the predominant circulating variants, the severe form of COVID-19 has become rare,” he said.
The drug may still be of value for those at high risk of severe disease, but unless there’s an increase in such cases, demand is likely to remain low, he said.
