COVID-19 care: what you need to know about the latest treatments

You are probably wondering what treatment options are available if you or a loved one tests positive. And you may be concerned about the potential side effects of these medications. Summit Health’s Khushbu Thaker-Desai, PharmD, clinical pharmacist, and Ashish Parikh, MD, internal medicine physician and chief quality officer, discuss the latest thinking on COVID-19 care.

What treatments are available?

For mild to moderate COVID-19 in the outpatient setting, two types of treatment are available: antivirals and monoclonal antibodies.

“Antivirals target a specific part of the virus to stop it from multiplying in your body while monoclonal antibodies help your body’s immune system fight the virus more effectively,” explains Dr. Thaker-Desai.

The antivirals that are available include:

• Nirmatrelvir/ritonavir (brand name Paxlovid^TM), which you take by mouth at home
• Molnupiravir (brand name Lagevrio^TM), also given orally in pill form
• Remdesivir (brand name Veklury^®), administered as an intravenous (IV) infusion at a health care facility

Monoclonal antibodies are a therapy that consist of manufactured antibodies. These antibodies mimic the ones the body makes naturally and are given to help fight off infection. The treatment is given either by injection or through IV at health care facilities.

“Several antibody formulations are effective against the different variants, with bebtelovimab being the one that is most effective against the currently circulating variants,” says Dr. Thaker-Desai.

What’s best for you?

Currently, the National Institute of Health (NIH) recommends oral antiviral treatment with nirmatrelvir/ritonavir as the primary option. “This medication has been found to be highly effective in reducing the risk of progression to severe disease,” says Dr. Parikh. “However, nirmatrelvir/ritonavir also interacts with many common medications. During antiviral therapy, some of these medications may need to be stopped or the dose may need to be lowered. The other oral medication, molnupiravir, is usually reserved for those who cannot take nirmatrelvir/ritonavir.” 

IV antivirals are typically a second choice, followed by monoclonal antibody treatments as a third option. While they are effective, Dr. Parikh notes that both options “require administration at a health care facility.”

Dr. Parikh says your health care provider will make the best decision for you based on more than just convenience. Factors include:

• Age
• Chronic conditions and other risk factors for progression to severe disease
• Interactions with other medications
• Kidney and liver function
• Pregnancy status and childbearing potential

Who is eligible?

Patients who have tested positive for COVID-19 can qualify for outpatient treatments if they are not in the hospital and are at high risk of experiencing severe illness. Dr. Thaker-Desai explains these high-risk factors would include patients with:

• Immune system dysfunction
• A condition that requires them to take immunosuppressive medications
• Chronic medical conditions such as cancer, diabetes, hypertension, obesity, lung, or heart disease, and others.

Additionally, you must be at least 12 years old to take nirmatrelvir/ritonavir and bebtelovimab and at least 18 years old to be eligible for molnupiravir. Young children weighing at least 7.7 pounds may qualify for IV antivirals.

Oral antivirals must be started within five days of when symptoms start, while IV antivirals and monoclonal antibodies should be taken within seven days. The earlier the administration, the more effective the treatments will be.  

What are the side effects?

According to Dr. Thaker-Desai, the range of side effects depends on the medication. 

Mild side effects include:

• Upset stomach
• Change in taste
• Nausea
• Dizziness

Serious side effects include:

• Increase in blood pressure
• Increase in liver enzymes
• Rash
• Severe or life-threatening allergic reactions
• Infusion-related reactions, such as itching, fever, chills, sweating

“Overall, these medications are well tolerated; however, your provider and you should discuss the benefits of the medication and the potential risk to determine which treatment is best for you,” says Dr. Thaker-Desai. 

Should I be concerned about COVID-19 rebound after any treatments?

Recently, there have been reports of Paxlovid being linked with the potential recurrence of COVID-19, also known as COVID-19 rebound. According to the Centers for Disease Control & Prevention, Paxlovid continues to be recommended for patients, when indicated, and a brief return of symptoms may be part of the natural history of COVID-19 in some persons that is entirely independent of treatment. Additional doses of Paxlovid are not recommended once you have completed the initial course.  

What should you do if you don’t qualify?

Dr. Parikh recommends that you visit your health care provider, especially if you're at risk of getting very ill. “Based on your symptoms and risk factors, your provider will work with you to ensure you are staying well-hydrated and that your chronic medical conditions are well controlled. They will also monitor your symptoms to ensure they are not progressing,” adds Dr. Parikh.

What else can individuals do to reduce their risk of COVID-19?

“Getting vaccinated is still the most effective way to reduce your risk of developing severe illness if you get COVID-19,” says Dr. Parikh. “Make sure you know how many doses are recommended for you and stay up to date with boosters. While vaccination may not be as effective in preventing infection with the new variants as they were for the original strain, they still reduce your risk of getting very sick by 90 percent.”