Before the omicron surge, studies in patients showed Paxlovid reduced the risk of hospitalization and death by up to 88%. Against omicron, Pfizer says that initial laboratory studies show Paxlovid is still effective.
The main issue is side effects. The FDA has published a fact sheet for health care providers on Paxlovid. It’s 29 pages and 12 of those pages list potential side effects. They include possible severe or life-threatening interactions with widely used medications, including statins to lower cholesterol, blood thinners and some antidepressants.
Made by Merck, molnupiravir — brand name Lagevrio — is also a five-day regimen of pills that should be started as soon as possible after diagnosis. Like Paxlovid, a prescription is required and it’s not to treat someone who has severe COVID symptoms. Studies showed no benefit of the drug if it’s taken after the COVID symptoms have already worsened significantly. Only patients 18 and over are eligible, because the drug may affect bone and cartilage growth.
In tests, Lagevrio was shown to reduce the risk of hospitalization and death by about 30%. Initial laboratory studies showed it also worked against omicron. It’s not recommended for women who might be pregnant, because of the risk it may damage a fetus.
Remdesivir is also an antiviral, but it’s given as an intravenous infusion over several days in a medical setting.
Made by Gilead under the brand name of Veklury, it originated to treat other diseases and has been available to treat COVID since Spring 2020. It is now fully approved by the FDA, unlike the newer antiviral pills that are still just authorized for emergency use.
Eli Lilly’s bebtelovimab is the only monoclonal antibody treatment for COVID-19 currently authorized by the FDA. On Feb. 11, the FDA granted emergency use authorization for this drug for non-hospitalized COVID patients at high risk of developing severe disease. It is administered as an intravenous injection.
The FDA announced it was no longer authorizing other monoclonal antibody treatments for COVID because they are no longer effective against the omicron variant. If omicron recedes and other variants appear that the drugs work on, the FDA said authorization could be restored in places with outbreaks.
These drugs don’t work unless they’re given before a patient gets infected with the virus.
Evusheld is a two-drug injection regimen made by AstraZeneca that can bolster the immune system against COVID. It’s not a vaccine, but like a vaccine it must be taken before a person gets infected.
The two drugs are monoclonal antibodies. There is evidence that Evusheld still works against the omicron variant. People who are eligible include people with compromised immune systems, like cancer patients, and people who medically can’t be vaccinated. People may not receive Evusheld while they are infected with COVID-19.
The Pfizer and Moderna vaccines, especially with a booster shot, have continued to demonstrate strength against the omicron variant of the virus. Vaccinated people can still get infected with omicron, but if so they are much less likely to go to the hospital or die.
While Johnson & Johnson’s vaccine is still available, the FDA has imposed new restrictions saying the risk of blood clotting and bleeding posed by that vaccine outweighed the benefits of the vaccine for people who are 18 or older and can get another shot. The FDA said only people who are unable to receive other vaccines should receive the Johnson & Johnson shot.