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June 2024: Expanded use of nirmatrelvir plus ritonavir (Paxlovid) for COVID-19

The use of nirmatrelvir plus ritonavir (Paxlovid) for patients with COVID-19 who do not require hospitalisation is defined by NICE technology appraisal [TA878]. NICE has published an update to TA878 to expand the patient groups eligible for treatment with Paxlovid and has recommended a phased implementation starting with the following additional patient groups:

• people aged 85 years and over
• adults with end-stage heart failure who have a long-term ventricular assistance device
• adults on the organ transplant waiting list
• people aged 70 years and over, or who have a BMI of 35 kg/m² or more, diabetes or heart failure, and:
  • are resident in a care home, or
  • are already hospitalised.

All patients must meet all initial assessment criteria for a COVID-19 treatment:

• they must be symptomatic with COVID-19, present within 5 days of the onset of symptoms, have a positive COVID-19 test, and should not require either supplemental oxygen or hospitalisation for COVID-19.

Clinicians are reminded there is a significant risk of potentially serious or harmful drug interactions with Paxlovid. Do not prescribe Paxlovid without carefully considering whether it is appropriate for the patient (refer to the Devon Formulary guidance).

The new patient groups are not eligible for an alternative COVID-19 treatment if Paxlovid is contraindicated or not appropriate.

Participating community pharmacies have been commissioned to provide lateral flow devices to the new patient groups.

Further patient groups will be added during the course of the year when the next implementation phase for TA878 is launched.

Updated Devon Formulary and Referral guidance:

• Formulary guidance: (N&E Devon / S&W Devon)
• Clinical referral guidance (N&E Devon / S&W Devon)

See here for other recent updates to the formulary