Gerald Smetana, MD: Outpatient COVID-19 Treatment Relies on Primary Care Providers

An important presentation featured at Pri-Med West 2022 was "New Drugs for the PCP: Outpatient Treatment of COVID-19" led by Gerald Smetana, MD, Professor of Medicine, Harvard Medical School, Clinician Educator, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center.

Smetana highlighted the key points of his presentation and went into a detailed discussion of the outpatient treatment options for the virus in an interview with HCPLive. Every year at this conference, he talks about new drugs in primary care, but this year, Smetana decided to use his limited time on stage to focus on outpatient management of COVID-19.

"I really think it's the most important new drug advance for primary care clinicians," he said, "and in particular, I think, because many of us might be uncomfortable in that venue, and not confident in prescribing these medicines."

Prescribing Monoclonal Antibodies

Smetana acknowledged that PCPs might be hesitant to prescribe monoclonals because they think these drugs are outside of their usual scope of practice, which is true, he said. However, the current position of primary care providers puts them in the role of prescribing outpatient treatments for the virus and he encouraged providers to get comfortable with monoclonal antibodies.

"We're on the front lines, we're the ones who are getting these phone calls," Smetana explained, "and we just simply don't have the time between when symptom onset occurs and patients have to be treated to get those types of subspecialty consultations."

With the emergence of various strains of COVID-19, the treatment landscape is ever-changing. And while he talks about the various monoclonal antibodies, right now, bebtelovimab is the only one that's retained an emergency use authorization (EUA) from the US Food and Drug Administration (FDA) for all variations of the virus.

The Oral Antiviral Treatment for COVID-19

Nirmatrelvir-ritonavir (Paxlovid) is the first oral antiviral treatment of COVID-19 that's been deemed safe for the same indication as bebtelovimab--outpatients with the virus who are at risk of progression to severe disease. In addition to being safe, a primary advantage to this drug is that it's administered orally, rather than needing infusions like monoclonal antibodies.

Smetana clarified that a few important things providers need to consider to when prescribing nirmatrelvir-ritonavir. It's crucial to be very thorough when checking for drug interactions. Also, the adjusted dosage guidelines for patients with kidney disease must be followed.

The treatment was approved in December and needs to be given to the patient within 5 days of symptom onset. Fortunately, nirmatrelvir-ritonavir has recently become available in commercial pharmacies and should be widely accessible now in most communities, according to Smetana.

"This is possible to get at local pharmacies, not just academic medical centers," he said. "It has to be given within 5 days of symptom onset, which is an important barrier. So, patients have to call us as soon as possible after testing positive. And because we do have that short window, this is why, you know, we're going to be the primary prescribers for that drug."