Coronavirus Oral coronary drugs seem to be effective in protecting against death – To whom are they given in Finland?

Oral corona drugs do not become a folk medicine in Finland, says Asko Järvinen of Husin. STMs also report that new drug therapies are likely to be targeted at the groups of patients most at risk for severe disease.

Helsinki and the Chief Physician of the Uusimaa Hospital District (Hus) Asko Järvisen According to Finland, medicines intended for the treatment or prevention of coronary heart disease do not become a folk medicine in Finland.

“The drug should be used for the right target groups, ie those who do not get enough benefit from vaccinations,” says Järvinen.

This means, for example, severely immunodeficiency, which is defined as a risk group for coronary heart disease.

“Extensive use, on the other hand, is hardly necessary, neither for people themselves nor for social investment.”

Also specialist Elina Asola the Ministry of Social Affairs and Health (STM) says new drug therapies are likely to be targeted at the groups of patients most at risk for severe disease.

According to a report published earlier by STM in May, treatment guidelines for starting the use of antiviral drugs at a low threshold need to be evaluated and developed in Finland, if necessary. The red thread in the report is preparing for future waves of epidemics.

Read more: Finland is already preparing for the next Korona wave: Inpatient wards should be able to treat up to a thousand patients in the autumn

Corvary drugs are not expected to curb the epidemic peak predicted for next autumn, Järvinen believes. The same goes for hospital workloads.

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“It is increasingly rare for coronary heart disease to lead to hospitalization or intensive care. Instead, I believe the epidemics will be seen in nursing homes and hospitals, just like the flu waves. ”

European To date, eight medicines for the treatment or prevention of coronary heart disease have been authorized by the European Medicines Agency. The majority is available through the EU Joint Procurement Mechanism. Contract negotiations are now underway.

Asola does not provide details of the negotiations, such as the amount of medicine tentatively ordered by Finland. However, he reveals that the goal is to get more new drug treatments available during the summer.

Bilateral purchases in Finland are made through Hus. In addition, STM has authorized Hus for warehousing and distribution tasks.

Pfizer Paxlovid has shown promising results worldwide. Obtained in Hong Kong during the sub-variant wave BA.2 of the spring omicron, peer-reviewed research results the drug reduced the risk of mortality for infected home patients by 75 percent and reduced the risk of hospitalization by 31 percent.

Another drug developed for the treatment of coronavirus, molnupiravir from Merck, was also found in the study to reduce the risk of mortality in patients with coronary heart disease at home. The risk of hospitalization with molnupiravir was similar to that in the control group. Molnupiravir blocks the replication of the virus.

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Paxlovid has shown promising results in reducing both mortality and hospitalization in clinical trials, with few side effects, says Professor of Zoonotic Virology at the University of Helsinki. Olli Vapalahti.

It is made up of two medicines: nirmatrelviir, which blocks the action of a viral protein breakdown enzyme, and ritonavir, which gives the medicine a longer effect.

However, Järvinen points out that Paxlovid has not been studied in a group at risk for severe coronary heart disease.

Especially Paxlovid has a lot of expectations in the treatment of a pandemic. President of the United States Joe Biden the administration has indicated that it wants to further increase the availability and use of the drug.

The U.S. Food and Drug Administration granted the drug an emergency license in December. According to Reuters, more than 160,000 courses of Paxlovid were prescribed in the country last week, compared with an average of 30,000 a week at the end of last year.

Paxlovid’s emergency license requires it to be used only in people who have recently had a positive test result and are at risk for a serious illness, but many others have asked for prescriptions, according to doctors interviewed by Reuters.

The use of antiviral drugs cannot be expanded.

Vapalahti reminds that the use of antiviral drugs cannot be expanded. For example, Paxlovid has a number of interactions with other medicines.

“People with multiple illnesses have a lot of medications, and because of that, these can’t be automatically started when people are diagnosed. A consultation with a competent doctor is needed, ”says Vapalahti.

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In Järvinen’s opinion, it would be important that common criteria be drawn up for the possible use of the medicine in different parts of Finland. This would ensure consistent treatment.

In addition, Järvinen believes that it is important to balance the benefits of medicines. Medicines should not be given to people who may be at greater than risk.

Corona drugs are valuable. In the United States, for example, the Biden administration has promised to pay for coronary drugs for those in need. According to Reuters, one course of Paxlovid is about $ 530 (€ 490) and a course of molnupiravir is about $ 700 (€ 650).

Of course, drug treatment is not just a cost, Järvinen points out. It is difficult to lower the price for deaths or the prevention of long-term illnesses.

Recently, some cases of recurrence of symptoms following discontinuation of Paxlovid have been reported worldwide. According to Vapalahti, however, this is a relatively small group of drug users.

Vapalahti believes that antiviral drugs work well for the world’s leading sub-variants of the omicron transformation BA.4 and BA.5. Unlike vaccines, the mechanism of action of drugs does not apply to the peak protein, which undergoes the most changes during virus transformation.

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