COVID-19 Update #126 3/30/2022

A revised (3/28/2022) ICER review of drugs that are effective to treat the COVID-19 Omicron variant found that compared to no active treatment:

1. Nirmatrelvir/ritonavir (Paxlovid) likely has at least a small net health benefit and the possibility of a substantial net health benefit.
2. Molnupiravir is at least comparable and has potential for a small net health benefit.
3. Sotrovimab likely delivers at least a small benefit with the possibility of a substantial net health benefit. However, the report expressed concern for decreased susceptibility for the BA.2 Omicron Subvariant.
4. Fluvoxamine is at least comparable and has potential for a small net health benefit. However, NIH has determined there is not enough evidence to recommend for or against the use of fluvoxamine to treat COVID-19.​ 

Due to differences in trial population demographics, ICER did not feel the drugs could be compared based on current evidence. All four drugs were found to be cost effective, with a quality-of-life year gained (QALY) < $100,000. The cost of an averted hospitalization was also < $100,000.
 
COVID-19 Antibodies
 
The CDC found that sotrovimab is not active against the BA.2 Omicron subvariant. NIH (ASPR) will stop distributing sotrovimab in stares and territories where BA.2 has reached 50% frequency. This includes HHS Region 1 (Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont) and Region 2 (New Jersey, New York, Puerto Rico, and the Virgin Islands).
 
COVID-19 Vaccines
 
A Canadian retrospective analysis of 97,590 pregnant patients and a retrospective study of 157,521 singleton births in Sweden and Norway found that COVID-19 vaccination during pregnancy did not increase the risk of adverse peripartum outcomes compared with vaccination after pregnancy and with no vaccination. Most patients received an mRNA vaccine during the second and third trimester in both studies.
 
On 3/29/2022, the FDA approved a 4th dose (2nd booster) of mRNA #COVID-19 vaccines for patients 50 and older. In cetain immunocompromised patients the age is lowered to12 and older with the Pfizer-BioNTech vaccine and 18 and older with the Moderna vaccine. This decision was made before a scheduled meeting to discuss vaccine boosters. The FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC), CDC and NIH will meet on 4/6/2022 to discuss additional COVID-19 vaccine boosters and how to select specific SARS-CoV-2 virus strains for COVID-19 vaccines to address current and emerging variants.