The government will fully halt the use of the COVID-19 oral treatment "Lagevrio" on Mar. 17. The stock's shelf life is expiring. The system for oral treatments will effectively shift to operating with only one option, Paxlovid.
The Korea Disease Control and Prevention Agency said on the 26th that it will stop use of Lagevrio starting Mar. 17 as stocks supplied from government reserves have been depleted.
Until now, the government supplied two oral COVID-19 treatments (Paxlovid and Lagevrio) and one injectable, "Veklury." Among these, Paxlovid and Veklury received marketing authorization and have been used in medical settings with National Health Insurance coverage since Oct. 25, 2024.
By contrast, Lagevrio remained only under emergency use authorization without formal marketing approval and was supplied in a limited manner within the scope of government stock.
Paxlovid has been administered to mild to moderate patients among those 60 and older, people with underlying conditions, and the immunocompromised. However, because it has many drug interactions and cannot be used for patients with severe hepatic impairment, Lagevrio or Veklury has been used as an alternative for such patient groups.
With Lagevrio gone, the only option left is the injectable Veklury. In particular, primary clinics may increasingly need to refer patients who cannot take Paxlovid to hospital-level or higher institutions. This raises concerns about reduced access to treatment.
A variable is the expansion of Paxlovid's approval scope. The Ministery of Food and Drug Safety on Jan. 14 expanded Paxlovid's indicated population to include patients with severe renal impairment (including those on dialysis).
Patients with moderate renal impairment (eGFR 30–59 mL/min) take nirmatrelvir 150 mg and ritonavir 100 mg twice daily on days 1–5. Patients with severe renal impairment requiring hemodialysis (eGFR below 30 mL/min) take 300 mg/100 mg on day 1 and 150 mg/100 mg once daily on days 2–5. On dialysis days, dosing should occur after dialysis
Many patients with severe renal impairment who had been receiving Lagevrio because Paxlovid use was not recommended are expected to be eligible for Paxlovid prescriptions through dose adjustment.
The problem remains drug interactions. Paxlovid has as many as 40 contraindicated co-medications, and medical settings have pointed out that checking patients' current medications before prescribing is cumbersome.
The Korea Disease Control and Prevention Agency plans to produce and distribute detailed guidance on contraindicated co-medications based on the marketing authorization and, in cooperation with the Health Insurance Review & Assessment Service, provide prescribing precautions to medical institutions. It also plans to strengthen guidance to clinicians on dosing management.
Lim Seung-kwan, commissioner of the Korea Disease Control and Prevention Agency, said, "COVID-19 treatments remain an important means to protect high-risk groups," and noted, "We ask for active consideration of prescribing Paxlovid and guidance on the use of Veklury."