Question to the Department of Health and Social Care:

To ask Her Majesty's Government whether clinical guidelines have been produced about the prescription of longer courses of anti-virals for refractory infections in immunocompromised individuals; if not, what assessment they have made of the impact of a lack of guidelines on doctors’ ability to issue appropriate prescriptions; and what assessment they have made of the impact of the COVID-19 Medicines Delivery Unit’s decision-making processes on treatment access for patients with immunodeficiency.

Clinical access policies for the routinely available COVID-19 treatments in the National Health Service apply to treatment decisions being made by clinicians working with COVID Medicine Delivery Units in England. These decisions typically reflect the use within a medicine’s marketing authorisation, including the dose and duration of treatment to be provided, although there are mechanisms which allow the consideration of off-label use. The RAPID C-19 collaboration, led by the National Institute for Health and Care Excellence, monitors any emerging evidence from clinical trials which informs these clinical access decisions.

The clinical access policy states that the antivirals molnupiravir and nirmatrelvir+ritonaivir should be taken for five days. Any treatment duration beyond the marketing authorisation is not included in this policy unless it is supported by evidence on the benefit and safety in clinical trials. No specific assessment of the impact of prescription guidelines and the COVID-19 Medicine Delivery Units’ decision-making process has been made.