National Antiviral Service Cymru (NAVS)
The National Antiviral Service Cymru (NAVS) is co-ordinating the supply of treatments for COVID‑19 for the most vulnerable individuals across Wales who have not been admitted to hospital.
Information for Healthcare Professionals
The following information and resources are aimed at healthcare professionals. Members of public can access information about the National Antiviral Service (NAVS) from this site.
NICE guidance [TA878] published on COVID-19 treatments
On 29 March 2023, NICE published evidence-based recommendations on casirivimab plus imdevimab (Ronapreve▼®), nirmatrelvir plus ritonavir (Paxlovid▼®), sotrovimab (Xevudy▼®) and tocilizumab (RoActemra®) for treating COVID-19 [TA878].
This evaluation reviews the clinical and cost effectiveness of treatment options for mild COVID-19 and for severe COVID-19. The recommendations can be accessed via the NICE website.
National Antiviral Service Pathway
The NHS Wales National Antiviral Service Referral Pathway provides a consistent way of triaging and assessing individuals for either an oral antiviral preparation, or referral to the local health board within which they reside for an infusion of a neutralising monoclonal antibody (nMAB).
Interim Clinical Commissioning Policy Treatments
Update The published UK-wide policy has been updated, effective with immediate effect, to provide access to antiviral treatment options for eligible individuals, based on a review of the latest available evidence.
Rapid Policy Statement Interim Clinical Commissioning Policy: Treatments for non-hospitalised patients with COVID-19. Effective from 28 November 2022
A decision aid (only accessible from an NHS Wales networked computer) has been developed to help maximise Paxlovid▼® use.
Eligibility Criteria
The eligibility criteria are specified in the UK-wide Clinical Commissioning Policy and are available in this NAVS table.
Referral Portal
Healthcare professionals should use the information in the UK-wide Clinical Commissioning Policy to decide whether a patient is likely to be eligible for treatment. Where a healthcare professional considers a patient may be eligible for treatment, they can refer them for review by NAVS via an online portal. Patients can self-refer via the Self-Referral Portal or can call NHS 111 Wales.
Extended use of antivirals beyond labelled expiry dates
The Department of Health and Social Care (DHSC) and pharmaceutical company Pfizer have extended the shelf life of specified batches of Paxlovid▼® (nirmatrelvir 150mg and ritonavir 100mg) film-coated tablets.
The DHSC and pharmaceutical company MSD have extended the shelf life of specified batches of Lagevrio▼® (molnupiravir) 200mg hard capsules.
Some expiry dates have been extended following assessment by the Medicines and Healthcare products Regulatory Agency (MHRA). The list of specified batches can be found on the GOV.UK website:
- Paxlovid (nirmatrelvir 150mg and ritonavir 100mg) film-coated tablets expiry date extended – GOV.UK (www.gov.uk)
- Lagevrio (molnupiravir) 200mg hard capsules expiry date extended – GOV.UK (www.gov.uk)
The following Direct Healthcare Professional Communications have also been circulated regarding these changes:
- Paxlovid▼® Shelf-life Extension, Including Extended Use Beyond Labelled Expiry Date
- Lagevrio▼® Extended Use Beyond Labelled Expiry Date
Patient Group Directions (PGDs)
The national COVID-19 treatment PGD templates are available below. The sotrovimab PGD template is for adaptation by local health boards.
The national COVID-19 treatment PGD for oral antivirals is being run centrally for the whole of Wales within Cardiff and Vale University Health Board by the National Antiviral Service (NAVS Cymru). Copies of the PGDs are provided for information.
UK-wide Clinical Commissioning Policy Documents
The latest clinical commissioning policy documents can be accessed via the All Wales Therapeutics and Toxicology Centre (AWTTC ) COVID-19 therapies – alerts and advice page; under the ‘Neutralising monoclonal antibodies or antivirals’ section
COVID-19 “Rebound” associated with Paxlovid▼® treatment
Cases of COVID-19 rebound following treatment with nirmatrelvir/ritonavir have been noted. The NAVS team have been involved in highlighting case reports, which you can read more about in this Journal of Infection letter.
- Coulson JM, Adams A, Gray LA, Evans A. COVID-19 “Rebound” associated with nirmatrelvir/ritonavir pre-hospital therapy. J Infect. 2022; S0163-4453(22)00363-2. Online ahead of print. doi: 10.1016/j.jinf.2022.06.011
NAVS webinar
This recorded webinar focuses on the NHS Wales community deployment of neutralising monoclonal antibodies (nMABs) or antivirals for non-hospitalised patients with COVID-19.
Other useful resources
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- Summary of Product Characteristics (SmPC) – Xevudy▼®
- Summary of Product Characteristics (SmPC) – Paxlovid▼®
- Summary of Product Characteristics (SmPC) – Lagevrio▼®
- NHS Medicines A to Z
- University of Liverpool COVID-19 Drug Interactions Checker
- NHS Specialist Pharmacy Services (SPS): medicines interactions with nirmatrelvir and ritonavir (Paxlovid▼®)
- PANORAMIC trial website
29 Mar 23
NICE guidance [TA878] added.
22 Dec 22
Expiry date extension information added.
26 Oct 22
Paxlovid PGD updated. Decision aid link added.
25 Oct 22
Paxlovid PGD updated. Treatment options evidence review added.
07 Sep 22
NAVS Referral Pathway added, eligibility criteria and PGDs updated.
11 Jul 22
Webinar link added.
01 Jul 22
Eligibility criteria and PGDs updated.
22 Jun 22
COVID-19 “Rebound” article added.
06 Apr 22
Published.
