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Treatments like sotrovimab, molnupiravir, Paxlovid and Evusheld could lead to a new strategy in 2022: tackling covid-19 soon after infection to prevent severe symptoms from developing

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Prescriptions of pills that can be taken at home could help prevent people developing severe covid-19

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People in the UK who are at higher risk for covid-19 can now help trial the first antiviral pill for this infection that can be taken at home, while those who are classed as extremely vulnerable can get antibody infusions as soon as they test positive.

“These are potentially game-changing drugs,” says Philip Evans at the UK National Institute for Health Research. So how will the new treatments be delivered and how effective are they?

When the pandemic began, doctors had no treatments for covid-19 other than general supportive care, such as giving people oxygen. Then, certain drug treatments became available, but they have mostly focused on tackling severe symptoms and have had to be given in hospital settings.

Throughout 2021, though, new treatments were developed that are intended for use when a person first becomes infected and symptoms are still mild. The hope is that by giving such medicines as soon as possible after a positive test, people are less likely to get sick enough to need a hospital stay.

Sotrovimab and molnupiravir

In the UK, people who are most vulnerable to covid-19 should by now have received letters containing a PCR test and advice that if they develop symptoms, they should take the test and call a special clinic to discuss treatment. This includes people with cancer, people with Down’s syndrome or those with very weak immune systems.

About 70 hospital clinics called Covid Medicines Delivery Units have been set up around the UK to help these groups. The main treatment on offer is an intravenous therapy called sotrovimab, an artificial antibody designed to block the coronavirus. A different antibody mixture called Ronapreve had originally been planned for use, but early lab tests suggest this is less effective against the omicron variant, while sotrovimab maintains enough efficacy to be useful.

The clinics also offer an oral treatment, called molnupiravir, which trials found cut hospital admissions by 30 per cent if taken within the first five days after infection.

The pill was made available in the UK in December through a mass trial for people not classed as extremely vulnerable, but who are still at somewhat higher risk from covid-19. This includes those 50 and over, or 18 and over with a medical condition such as diabetes or severe asthma.

While the UK was the first country to approve molnupiravir, in November, the health services decided a further 10,000-person trial is needed, to see how effective the drug is in a highly vaccinated population as the omicron variant spreads through the UK.

Half of those who sign up are being couriered a five-day course of molnupiravir, while the rest get no extra treatment. Anyone can sign up for it on a website if they have had symptoms begin in the past five days, have had a positive lateral flow or PCR test and meet the risk criteria.

With the UK in the middle of an omicron surge, 700 people have so far joined the trial and some results are expected in the next few months, says Evans. If molnupiravir is found to be beneficial when used like this, the plan is for it to be prescribed by family doctors the way that GPs prescribe many other drugs.

Molnupiravir has potential downsides, though. It works by introducing mutations in virus DNA, so anyone pregnant or breastfeeding cannot take it in case it harms their fetus or baby. Participants capable of getting pregnant will be sent a pregnancy test and must use contraception.

Another concern is that the viral mutations could lead to the emergence of dangerous new variants or drug resistance. Researchers are genetically sequencing virus samples from those taking the medicine to check for this.

David Lowe at University College London, who is involved in the trial, says mutations aren’t a big worry. “Once you’ve given [the drug] for a few days, the level of infectious virus is so low that you can’t even culture it. But it is something that we need to keep an eye on,” he says.

Paxlovid

The mass trial, which is called Panoramic, is an unusual “platform” design, in that if further antiviral drugs or antibodies are approved, they can be slotted in. This may happen soon with another antiviral oral pill called Paxlovid, which may reduce the risk of developing severe covid-19 by nearly 90 per cent.

Paxlovid consists of a drug that blocks an enzyme the coronavirus needs to reproduce – a similar mechanism to some anti-HIV drugs – as well as another compound that slows the drug’s breakdown. Paxlovid is currently under review for approval in the UK. The US Food and Drug Administration gave the drug emergency approval on 22 December.

Evans points out, however, that the eye-catching 90 per cent efficacy results reported for the drug haven’t yet been fully scrutinised by independent scientists in a peer-reviewed paper. The initial results for molnupiravir suggested it had 50 per cent efficacy, but this later fell to 30 per cent. “That’s why [scrutiny] is really important,” says Evans.

Looking ahead

“Vaccines will remain the cornerstone of our fight against covid-19, but with various new variants coming along, the oral [treatments] may well have a very important part to play in the next year,” says Evans.

In 2022, the Panoramic trial will expand to give antivirals to household contacts of people with covid-19, an approach known as post-exposure prophylaxis. Another addition to the trial could be a long-acting antibody injection called Evusheld, which was approved in the US in December.

Evusheld is thought to give protection against infection for up to six months and is aimed at people with weak immune systems or those who have had bad reactions to covid-19 vaccines or their ingredients.

“If one or more [of these treatments] is proven to be effective and safe in the community, it would add a new weapon in the armoury against covid-19,” says Evans.

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Solar storms may cause up to 5500 heart-related deaths in a given year

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In an approximate 11-year cycle, the sun blasts out charged particles and magnetised plasma that can distort Earth’s magnetic field, which may disrupt our body clock and ultimately affect our heart



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17 June 2022

A solar storm

Jurik Peter/Shutterstock

Solar storms that disrupt Earth’s magnetic field may cause up to 5500 heart-related deaths in the US in a given year.

The sun goes through cycles of high and low activity that repeat approximately every 11 years. During periods of high activity, it blasts out charged particles and magnetised plasma that can distort Earth’s magnetic field.

These so-called solar storms can cause glitches in our power grids and bring down Earth-orbiting satellites. A handful of studies have also hinted that they increase the risk of …

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UK Covid infection rate rising, with more than a million cases in England | Coronavirus

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Coronavirus infections are rising in the UK, figures have revealed, with experts noting the increase is probably down to the more transmissible BA.4 and BA.5 Omicron variants.

The figures from the Office for National Statistics (ONS), based on swabs collected from randomly selected households, reveal that in the week ending 11 June an estimated one in 50 people in the community in England are thought to have had Covid – around 1.13 million people.

The figure is even higher, at one in 45, in both Wales and Northern Ireland, while it was highest in Scotland where, in the week ending 10 June, one in 30 people are thought to have been infected.

While the figures remain below the peak levels of infection seen earlier this year, when around one in 13 people in England had Covid, the findings are a rise on the previous week where one in 70 people in England were thought to be infected. Furthermore, the data reveals increases in all regions of England, except the north-east, and across all age groups.

Experts say that a key factor in the increase is probably the rise of the Covid variants of concern BA.4 and BA.5.

“Infections have increased across all four UK nations, driven by rising numbers of people infected with the BA.4 and BA.5 Omicron variants,” said Kara Steel, senior statistician for the Covid-19 Infection Survey.

While Steel said it remained too early to say if this was the start of another wave, others have warned it may already have begun, with increased mixing and travelling among other factors fuelling a rise in cases.

Among concerns scientists have raised are that BA.4, BA.5 and another variant on the rise, BA.2.12.1, replicate more efficiently in human lung cells than BA.2.

Prof Azra Ghani, an epidemiologist at Imperial College London, said the latest figures were not surprising, and might rise further.

“This increase in infection prevalence is likely due to the growth of the BA.4 and BA.5 Omicron subvariants, which as we have seen elsewhere in Europe, appear to be able to escape immunity generated from previous Omicron subvariants,” she said.

“It is therefore possible that we will continue to see some growth in infection prevalence in the coming weeks and consequently an increase in hospitalisations, although these subvariants do not currently appear to result in any significantly changed severity profile. This does however serve as a reminder that the Covid-19 pandemic is not over.”

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NHS to offer women in England drug that cuts recurrence of breast cancer | Breast cancer

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Thousands of women in England with breast cancer are to benefit from a new pill on the NHS which reduces the risk of the disease coming back.

The National Institute for Health and Care Excellence (Nice) has given the green light to abemaciclib, which cuts the chance of breast cancer returning after a patient has had surgery to remove a tumour.

Trials showed that patients who had the drug with hormone therapy had a more than 30% improved chance of their cancer not coming back after surgery, compared with hormone therapy alone.

“It’s fantastic thousands of women with this type of primary breast cancer will now have an additional treatment option available on the NHS to help further reduce the risk of the disease coming back,” said Delyth Morgan, the chief executive of charity Breast Cancer Now.

“The fear of breast cancer returning or spreading to other parts of their body and becoming incurable can cause considerable anxiety for so many women and their loved ones.

“New effective treatments such as abemaciclib, which can offer more women the chance to further reduce the risk of the disease recurring, are therefore extremely welcome and this is an important step change in the drug options available for this group of patients.”

The twice-a-day pill is suitable for women with hormone receptor-positive, HER2-negative, node-positive early breast cancer at high risk of recurrence who have had surgery. About 4,000 women will benefit initially, Nice said.

Helen Knight, the interim director of medicines evaluation at Nice, said the draft recommendation came less than a month after abemaciclib received its licence.

“The fact that we have been able to produce draft recommendations so quickly is testament to the success of our ambition to support patient access to clinically and cost effective treatments as early as possible,” said Knight. “Until now there have been no targeted treatments for people with this type of breast cancer.

“Abemaciclib with hormone therapy represents a significant improvement in how it is treated because being able to have a targeted treatment earlier after surgery will increase the chance of curing the disease and reduce the likelihood of developing incurable advanced disease.”

Abemaciclib works by targeting and inhibiting proteins in cancer cells which allow the cancer to divide and grow. It normally costs £2,950 for a packet of 56 150mg-tablets, but the manufacturer, Eli Lilly, has agreed an undisclosed discounted price for NHS England.

“Thanks in part to this latest deal struck by NHS England, NHS patients will be able to access another new targeted drug for a common and aggressive form of breast cancer,” said Prof Peter Johnson, the cancer director of NHS England.

“Abemaciclib, when used alongside a hormone therapy, offers a new, doubly targeted, treatment option, helping to increase the chances of beating the cancer for good, as well as meeting the NHS’s commitment to delivering improved cancer care under our long-term plan.”

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