Unfortunately, ensitrelvir, like Paxlovid, interferes with the metabolism of tacrolimus, a common anti-rejection med for transplant patients. The transplant community desperately needs an effective oral antiviral for Covid. (Remdesivir is the preferred antiviral but has to be given IV on three consecutive days. Molnupiravir is taken orally but is much less effective).
With Paxlovid, that’s so difficult to do that most transplant centers avoid the drug entirely in patients taking tacro. I assume that the same would be true with ensitrelvir.
Hoping Ensitrelvir gets out of FDA limbo--it seems more effective than Paxlovid, currently cheaper and far less drug interactions. It would be nice to have another antiviral in the toolbox.
I'm not sure how well Ensitrelvir works in terms of hospitalization reduction. In the trial of symptom control, almost nobody was hospitalized. I'm not sure how well it works in that outcome, albeit at this point, I'm not convinced Paxlovid does much of that either (we expect new data soonish).
Thanks for the info on these various topics. Always appreciate your take on things. Question re: semaglutides vs tirzepatides. Is it safe to assume that the benefits of tirzepatide would be similar or does the added GIP receptor agonist mean that the benefits cannot be extrapolated, requiring their own research on things such as improvement in osteoarthritis. Thank you!
That is a GREAT question. I'm actually going to have Dr. Fatima Cody and Dr. Karl Nadolsky for a Q&A sometime soon. They're the docs who first got me really interested in this whole story two years ago. I'll ask! Please remind me when I post the preview to that (but I'll try to remember!)
"The editorial contends that GLP-1RAs not only facilitate weight loss, but also have pleiotropic anti-inflammatory and immunomodulatory effects. In osteoarthritis, these effects might be mediated in the central nervous system (where activation of neuronal GLP-1 receptor inhibits toll-like receptors, which, in turn, attenuate inflammatory cytokine production) or locally in the joint, since GLP-1 receptors are present in synovium, bone and cartilage"
Coincidentally I opened the above in a e-mail today. I took it for granted, reduced weight less strain on knee & other weight barring joints. The participants were not a large number, sub 500
In responding to this week’s poll I thought about selecting abortion/reproductive rights but opted to go with healthcare access and cost because abortion and reproductive care are two examples of healthcare. People need better and more affordable access to all healthcare including abortion and reproductive care.
Also, if someone gets covid again who has long covid does anyone know if it makes sense to ask a physician for a two week course of metformin to lessen viral effects for the person suffering the long covid plus the new covid ailment. Sorry if this is wordy ~
Metformin has been shown to reduce bad outcomes, but not so definitively that it is standard of care. I've prescribed it for acute covid to reduce the odds of long covid, but I don't know about people who already have LC.
My initial thought from a Phm perspective...logic & it's not a benign drug, however the short course presents more of challenge as to tolerating the dosage while increasing the daily dosage...gastric upset
For the non diabetic that adjustment is the bigger challenge not the 2 wk trial.
Does anyone know the timeline for the results of the covid nasal vaccine studies? Wondering if this is 2025 or 2026? My family keeps asking when there will be nasal vaccine option
Unfortunately, ensitrelvir, like Paxlovid, interferes with the metabolism of tacrolimus, a common anti-rejection med for transplant patients. The transplant community desperately needs an effective oral antiviral for Covid. (Remdesivir is the preferred antiviral but has to be given IV on three consecutive days. Molnupiravir is taken orally but is much less effective).
I was not aware of that. That's unfortunate. Do we know if dose adjustments of tacro can overcome that?
With Paxlovid, that’s so difficult to do that most transplant centers avoid the drug entirely in patients taking tacro. I assume that the same would be true with ensitrelvir.
Hoping Ensitrelvir gets out of FDA limbo--it seems more effective than Paxlovid, currently cheaper and far less drug interactions. It would be nice to have another antiviral in the toolbox.
I'm not sure how well Ensitrelvir works in terms of hospitalization reduction. In the trial of symptom control, almost nobody was hospitalized. I'm not sure how well it works in that outcome, albeit at this point, I'm not convinced Paxlovid does much of that either (we expect new data soonish).
Thanks for the info on these various topics. Always appreciate your take on things. Question re: semaglutides vs tirzepatides. Is it safe to assume that the benefits of tirzepatide would be similar or does the added GIP receptor agonist mean that the benefits cannot be extrapolated, requiring their own research on things such as improvement in osteoarthritis. Thank you!
That is a GREAT question. I'm actually going to have Dr. Fatima Cody and Dr. Karl Nadolsky for a Q&A sometime soon. They're the docs who first got me really interested in this whole story two years ago. I'll ask! Please remind me when I post the preview to that (but I'll try to remember!)
Thanks!
"The editorial contends that GLP-1RAs not only facilitate weight loss, but also have pleiotropic anti-inflammatory and immunomodulatory effects. In osteoarthritis, these effects might be mediated in the central nervous system (where activation of neuronal GLP-1 receptor inhibits toll-like receptors, which, in turn, attenuate inflammatory cytokine production) or locally in the joint, since GLP-1 receptors are present in synovium, bone and cartilage"
https://canadianhealthcarenetwork.ca/semaglutide-may-benefit-patients-knee-osteoarthritis-pain-and-obesity#:~:text=The%20editorial%20contends,bone%20and%20cartilage
Coincidentally I opened the above in a e-mail today. I took it for granted, reduced weight less strain on knee & other weight barring joints. The participants were not a large number, sub 500
In responding to this week’s poll I thought about selecting abortion/reproductive rights but opted to go with healthcare access and cost because abortion and reproductive care are two examples of healthcare. People need better and more affordable access to all healthcare including abortion and reproductive care.
Also, if someone gets covid again who has long covid does anyone know if it makes sense to ask a physician for a two week course of metformin to lessen viral effects for the person suffering the long covid plus the new covid ailment. Sorry if this is wordy ~
Metformin has been shown to reduce bad outcomes, but not so definitively that it is standard of care. I've prescribed it for acute covid to reduce the odds of long covid, but I don't know about people who already have LC.
My initial thought from a Phm perspective...logic & it's not a benign drug, however the short course presents more of challenge as to tolerating the dosage while increasing the daily dosage...gastric upset
For the non diabetic that adjustment is the bigger challenge not the 2 wk trial.
Does anyone know the timeline for the results of the covid nasal vaccine studies? Wondering if this is 2025 or 2026? My family keeps asking when there will be nasal vaccine option
I don't know but I can ask around!