#MSCOVID19 Antiv virals


Sadly the planned trip to Serbia to present on COVID and MS has been postponed, so I will have to cast my eye on the literature for a bit longer. In this paper they look at the use of anti-virals in people with infected with the COVID-19 virus. People on a few MS- DMT may be at extra risk from COVID-19 if they get infected so this info may be relevent. Here they conclude that the different anti-virals are more or less the same….I would say this view was pre-omicron as the omicron vraiants can escape the actions of therapeutic antibodies, as the authors say and probably convalescent serum, however with time this serum will come from omicron infected individuals and so they should work better.

Sullivan, D. J., Focosi, D., Hanley, D. F., Franchini, M., Ou, J., Casadevall, A., Paneth, N. Effective antiviral regimens to reduce COVID-19 hospitalizations: a systematic comparison of randomized controlled trials

MedRXiv 10.1101/2022.05.24.22275478 

Background. Antiviral therapy has a greater impact when provided early in the disease to outpatients, potentially preventing hospitalization and subsequent deaths, while reducing healthcare system pressure. Controversies persist about the best treatment option for COVID-19 outpatients at risk of disease progression to hospital. No head-to-head RCT has been conducted to compare the three major modalities in current use-oral/intravenous antivirals, monoclonal antibodies and COVID-19 convalescent plasma (CCP).

Methods. We assembled data from March 2020 to April 2022 from published outpatient RCTs examining authorized COVID-19 therapies with hospitalization as the major endpoint, and that also assessed mortality, symptom resolution, underlying risk factors for progression, timing and dose of the intervention in relationship to evolving variants of concern (VOC).

Findings. CCP, monoclonal antibodies and oral antivirals each had comparable efficacy converging to 80% hospital risk reduction dependent on the dose and the timing of the intervention. Most RCTs targeted populations with at least one risk factor for severe COVID-19. Control group hospitalizations were less than 10% in 16 of 20 RCTs. Amongst the effective two CCP trials, monoclonals and three antiviral small molecules, deaths were reduced by 90% from 44 total in combined control arm to 4 in intervention arms. The overall risk of bias was deemed low for nine studies and some concerns for eight. The I2 statistic heterogeneity amongst the outpatient trials with endpoint hospitalization is 73% (p- < 0.01). Interpretation. The emerging resistance of Omicron BA.2 and related sublineages (XE, BA.2.12.1, BA.4, and BA.5) to monoclonal antibodies suggests a pressing need to reevaluate CCP (nowadays largely available from vaccinees with high neutralizing antibody levels) for COVID19 outpatients at risk of disease progression, especially in settings with constrained medical resources.

Disclaimer: These are the authors view and no other

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  • Interesting that there is no mention of Paxlovid Rebound. Many MS patients on strong immuno suppressant medications have been given anti virals and quite a few have developed rebound covid after the initial course of anti virals.
    I was one of them and read about rebound on Twitter where hundreds of immuno suppressed patients have experienced it. My GP and MS team had no idea what was happening. I caught Covid at hospital having Ocrevus on 1 March. Tested positive on 6 March (PCR), Started paxlovid 7-12 March. Tested negative on 13 and 14 March. Came out of isolation, felt great. I became very ill again on 21 March, tested positive again (PCR) and received antibody infusion on 26 March. I was much more ill during the rebound and started antibiotics on 1 April. I finally recovered on 6 April. The hospital pharmacy and doctors did not know what was happening and thought I had caught the virus twice in under 20 days. It is now clear from all the reports worldwide that it was rebound infection.
    I will not take anti virals again unless the protocol is changed to ensure rebound doesn’t happen. Perhaps a later start to allow the body to recognise Covid and start to mount a defence and/or a longer course of 10 days.

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