New recommendations on drugs to be used to treat patients with Covid-19 arrive from the WHO. The new Guidelines continuously updated by a group of experts are published in the British Medical Journal. The recommendations released by WHO experts are based on the findings of seven studies involving over 4,000 patients with mild, severe or critical Covid-19 infection.
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by Irma D’Aria
The drug for rheumatoid arthritis
The first recommendation concerns baricitinib, a Janus kinase inhibitor already used for rheumatoid arthritis and strongly recommended for patients with severe or critical Covid-19 in combination with corticosteroids. WHO’s recommendation is based on scientific data showing that baricitinib improves survival and reduces the need for ventilation, without increasing adverse effects. This drug has similar effects to other arthritis therapies called interleukin-6 (IL-6) inhibitors, according to WHO experts. For this reason it is recommended that you choose between one of the two on the basis of the cost, its actual availability and the experience of the doctor. It is not recommended to use both drugs at the same time. Due to a possible increase in serious side effects, however, experts advise against the use of two other JAK inhibitors (ruxolitinib and tofacitinib) for patients with severe or critical forms of Covid-19.
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The monoclonal antibody
In the same update of the guidelines, WHO also makes a conditional recommendation for the use of the monoclonal antibody sotrovimab in patients with non-severe Covid-19, but only in those at higher risk of hospitalization. A similar recommendation was made by WHO for another monoclonal antibody, the casirivimab-imdevimab combination, but the experts point out that there is insufficient data to prefer one monoclonal antibody over another and that their efficacy against the new variants including Omicron is still uncertain. For this reason, the Monoclonal Antibody Guidelines will be updated as more data arrives.
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What are the WHO ‘Living Guidelines’
The recommendations relating to these drugs are part of the so-called ‘Living Guidance’, or the Guidelines that WHO continually updates to provide reliable guidance on the management of Covid-19 and help doctors make better decisions for their patients. Living guidelines are particularly useful in rapidly evolving research areas such as Covid-19 because they allow researchers to update care recommendations as new scientifically validated data and information arrive. Previously, the panel had made recommendations for the use of interleukin-6 receptor blockers and systemic corticosteroids for seriously or critically ill Covid patients; conditional recommendations for the use of neutralizing monoclonal antibodies in selected patients. Instead, it was expressed contrary to the use of ivermectin, hydroxychloroquine and the use of convalescent plasma in Covid patients regardless of the severity of the disease.
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