Covid antiviral access expanded

3 minute read

And the risk of MIS-C is lower for Delta and Omicron than it was with Alpha.

The government has expanded PBS access to covid antiviral drugs nirmatrelvir plus ritonavir (Paxlovid, Pfizer) or molnupiravir (Lagevrio, MSD), with the latest eligibility criteria for the streamlined authority listings taking effect on 11 July.

The drugs can be prescribed for people with covid confirmed by PCR or medically verified RAT and who can start treatment within five days of symptom onset (or as soon as possible after diagnosis where a patient is asymptomatic).

The list of immunocompromising conditions in the PBS eligibility criteria includes those where the patient has taken rituximab in the last 12 months.

Other eligibility criteria include immunocompromise related to the following medications taken in the last three months:

  • High dose corticosteroid treatment equivalent to >20mg/day of prednisone for ≥14 days in a month, or pulse corticosteroid therapy.
  • Selected csDMARDs, including: mycophenolate, methotrexate, leflunomide, azathioprine, 6-mercaptopurine (>1.5 mg/kg/day), alkylating agents (e.g. cyclophosphamide, chlorambucil), and systemic calcineurin inhibitors (e.g. cyclosporin, tacrolimus).
  • Biologic and targeted therapies that deplete or inhibit B cell or T cell function (including abatacept, anti-CD20 antibodies, BTK inhibitors, JAK inhibitors, anti-CD52 antibodies).

Access to the drugs has been broadened for adults with chronic respiratory conditions and people with disabilities who have multiple comorbidities.

In the general population, the age at which eligibility kicks in has been reduced, and now includes people with covid aged over 70, people aged over 50 but at high risk of severe disease, or Aboriginal or Torres Strait Islander people aged over 30 and at high risk of severe disease.

On 7 July, ATAGI issued updated recommendations for a covid vaccine winter dose, now recommended for adults aged 50-64. Adults aged 30-49 are also able to get one, though the benefits are less certain. Adults aged 65 and older were already eligible for a second booster, as well as certain other vulnerable populations.

ATAGI recommended earlier in the year that people with immunocompromise get a second booster shot, their fifth dose.

And in other covid news, Delta and Omicron infections are associated with a lower risk of multisystem inflammatory syndrome in children (MIS-C), even after taking account of vaccination, research suggests.
A population-based study using hospital and local registry data, published in Clinical Infectious Diseases, compared the incidence of MIS-C with the rate of new SARS-CoV-2 infections at various time points since the start of the pandemic, among 1.5 million children in southeast England.

Compared to the peak of the first Alpha variant wave in the UK, the incidence of MIS-C was 56% lower during the pre-vaccine Delta period, 66% lower in the post-vaccine Delta period, and 95% lower during the Omicron period.

More information

The Australian Rheumatology Association has links to covid resources for healthcare professionals and patients.

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