Covid-19: Two more drugs recommended for use by WHO


A healthcare worker attaches an intravenous (IV) infusion for a monoclonal antibody treatment to a patient’s hand in the parking lot of a hospital in Detroit, United States. The WHO conditionally approved an additional monoclonal antibody to treat Covid-19, as well as another drug used to treat rheumatoid arthritis. — Bloomberg

The drug baricitinib is strongly recommended for patients with severe or critical Covid-19, in combination with corticosteroids, said a World Health Organization (WHO) Guideline Development Group of international experts in The BMJ medical journal on Jan 13 (2022).

Their strong recommendation is based on evidence of moderate certainty that it improves survival and reduces the need for ventilation, with no observed increase in adverse effects.

Baricitinib is a type of drug known as a Janus kinase (JAK) inhibitor, which is also used to treat rheumatoid arthritis.

The WHO experts note that it has similar effects to other arthritis drugs known as interleukin-6 (IL-6) inhibitors, so when both are available, they suggest choosing one based on cost, availability and clinician experience.

It is not recommended to use both drugs at the same time.

However, the experts advise against the use of two other JAK inhibitors (ruxolitinib and tofacitinib) for patients with severe or critical Covid-19 because the evidence of low certainty from small clinical trials failed to show benefit, and indeed, suggests a possible increase in serious side effects with tofacitinib.

In the same guideline update, the WHO also made a conditional recommendation for the use of the monoclonal antibody sotrovimab in patients with non-severe Covid-19, but only in those at highest risk of hospitalisation, as there are only trivial benefits in those at lower risk.

A similar recommendation has been made by WHO for another monoclonal antibody drug casirivimab-imdevimab.

The experts also note that there were insufficient data to recommend one monoclonal antibody treatment over another – and they acknowledge that their effectiveness against new SARS-CoV-2 viral variants like Omicron is still uncertain.

As such, they say guidelines for monoclonal antibodies will be updated when additional data become available.

The latest recommendations are based on new evidence from seven clinical trials involving over 4,000 patients with non-severe, severe and critical Covid-19.

They are part of a living guideline, developed by the WHO with the methodological support of the Magic Evidence Ecosystem Foundation, to provide trustworthy guidance on the management of Covid-19 and help doctors make better decisions with their patients.

Living guidelines are useful in fast-moving research areas like Covid-19 because they allow researchers to update previously vetted and peer-reviewed evidence summaries as new information becomes available.

To make their recommendations, the panel considered a combination of evidence assessing relative benefits and harms, values and preferences, and feasibility issues.

The latest revised guidance adds to previous recommendations for the use of IL-6 receptor blockers and systemic corticosteroids for patients with severe or critical Covid-19; conditional recommendations for the use of casirivimab-imdevimab in selected patients; and against the use of convalescent plasma, ivermectin and hydroxychloroquine in patients with Covid-19, regardless of disease severity.

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