The WHO gave the green light this Friday to two new drugs against covid-19: baricitinib s sotrovimab. This is revealed by a new report by the World Health Organization’s Guideline Development Group (who) published in the journal the BMJ.
the drug baricitinib – a type of medication known as a Janus kinase (JAK) inhibitor and used to treat rheumatoid arthritis – is recommended for patients with Severe or critical Covid-19 in combination with corticosteroids. This announcement is based on “moderate certainty” evidence that it improves survival and reduces the need for mechanical ventilation, with no observed increase in adverse effects.
The drug baricitinib is recommended for patients with severe or critical covid-19 in combination with corticosteroids
To the Professor of Pediatric Rheumatology at the University of Bristol Athimalaipet Ramanan“The WHO’s strong recommendation comes at a much-needed time as many low- and middle-income countries continue to struggle with the pandemic.”
“Baricitinib has shown efficacy in randomized controlled trials in adults with moderate to severe disease, including those requiring ventilation. Its short half-life, oral administration and lower cost make it more attractive compared to tocilizumab –the other drug that proved effective in a similar scenario–”, adds the expert.
Although, Martin Landray, Professor of Medicine and Epidemiology at the University of Oxford, is more cautious in their statements to the Science Media Center: “The Recovery trial contains more than twice as much information about the effects of this drug as all previous trials combined. The results are not yet known. In my opinion, it would be prudent to wait until results are available before using baricitinib as an alternative to proven drugs like tocilizumab.”
In my opinion, it would be prudent to wait until results are available before using baricitinib as an alternative to proven drugs like tocilizumab.
Martin Landray, Professor of Medicine and Epidemiology at the University of Oxford
WHO experts note that baricitinib has similar effects to other arthritis drugs called interleukin 6 inhibitors (IL-6). So when both are available, they suggest choosing one based on cost, availability, and physician preference. In addition, they add that the use of both drugs at the same time is not recommended.
However, the use of two other JAK inhibitors (ruxolitinib s tofacitinib) in patients with severe or critical covid-19, since the results obtained in small trials have not shown benefits, and even suggest a possible increase in serious side effects with tofacitinib.
monoclonal antibodies
In the new update of the therapeutic guidelines against covid, the WHO also makes a conditional recommendation for the use of the monoclonal antibody sotrovimab in patients with non-severe Covid-19, but only for those at higher risk of hospitalization.
Landray explains that this monoclonal antibody, which has already been approved for use in the UK, “appears to be effective against the variant omicron”. However, “at the moment, we do not know whether it will be effective in reducing the length of hospital stay, in reducing the need for a mechanical ventilator or in improving the survival of the sickest patients”, emphasizes the professor at the University of Oxford.
The WHO also makes a conditional recommendation for the use of the monoclonal antibody sotrovimab in patients who are at greater risk of hospitalization.
The WHO made a similar recommendation for another monoclonal antibody drug (casirivimab-imdevimab). Experts also point out that there is not enough data to recommend one monoclonal antibody treatment over another, and acknowledge that its effectiveness against new variants such as omicron is still uncertain. Therefore, they state that the guidelines will be updated when more data becomes available.
For your part, Penny Ward, independent physician and visiting professor of pharmaceutical medicine at King’s College London, regrets that “the committee has not yet addressed the possible use of oral antivirals, whose use is already approved in several countries”.
“The guideline also does not reassess the position of the first approved antiviral, remdesivir, whose three-day treatment has been shown to prevent disease progression when administered within the first five days after the onset of symptoms.
WHO recommendations so far
The recommendations published today are based on the results of seven trials involving more than 4,000 patients with mild, severe, and critical COVID-19 infection.
The recommendations published today are based on the results of seven trials involving more than 4,000 patients with mild, severe, and critical COVID-19 infection.
The approvals of these new drugs complement previous recommendations on the use of interleukin-6 receptor blockers and systemic corticosteroids for patients with severe or critical COVID-19.
There are also currently conditional recommendations on the use of casirivimab-imdevimab (another monoclonal antibody treatment) in certain patients and the use of convalescent plasma, ivermectin and hydroxychloroquine in patients with covid-19, regardless of disease severity, is rejected.
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