The World Health Organization issues a strong recommendation for baricitinib and a conditional one for sotrovimab.
A World Health Organization (WHO) group has issued a strong recommendation for the use of baricitinib to treat patients with COVID-19 and a conditional recommendation for the use of sotrovimab to treat the disease.
Baricitinib, a type of Janus kinase (JAK) inhibitor, is used to treat rheumatoid arthritis, but can also treat individuals with critical or severe COVID-19 in combination with corticosteroids, according to a WHO Guideline Development Group of International experts and published in The BMJ.
Their recommendation is based on moderate certainty evidence that baricitinib improves survival and reduces the need for ventilation, with no observed increase in adverse effects.
The WHO experts said that baricitinib has similar effects to other arthritis drugs called interleukin-6 (IL-6) inhibitors, so when both are available, they recommend choosing a treatment based on availability, clinician experience, and cost.
Using both drugs at the same time is not recommended.
The experts advise against the use of 2 other JAK inhibitors, ruxolitinib and tofacitinib, for individuals with critical or severe COVID-19, because low certainty evidence from small trials failed to show a benefit and suggests a possible increase in serious adverse effects with tofacitinib.
In the same guidelines update, the WHO experts also conditionally recommended the use of the monoclonal antibody sotrovimab for individuals with non-severe COVID-19 but only those who are at highest risk of hospitalization, reflecting trivial benefits in those at lower risks.
The WHO experts made a similar recommendation for casirivimab-imdevimab, another monoclonal antibody drug.
There is insufficient data to recommend 1 monoclonal antibody treatment over another, and the WHO experts acknowledged that their effectiveness against new variants, such as omicron, is still uncertain.
The guidelines for monoclonal antibodies will be updated when additional data become available, the WHO experts said.
The new recommendations are based on new evidence from 7 trials that include 4000 individuals with critical, non-severe, and severe COVID-19 infection.
These recommendations are part of a living guideline, developed by WHO and the methodical support of MAGIC Evidence Ecosystem Foundation, to provide guidance on the management of COVID-19 and help physicians make better decisions for patients.
Living guidelines are useful in fast-moving research areas, such as COVID-19, because they allow investigators to update previously peer-reviewed and vetted evidence summaries as new information becomes available.
The panel considers a combination of evidence assessing relative benefits, feasibility, harm, preferences, and values to make their recommendations.
The new guidance adds to previous recommendations for the use of conditional recommendations for the use of casirivimab-imdevimab, another monoclonal antibody treatment, in selected individuals; IL-6 receptor blockers and systemic corticosteroids for individuals with critical or severe COVID-19; and against the use of convalescent plasma, hydroxychloroquine, or ivermectin in individuals with COVID-19, regardless of disease severity.
WHO recommends two new drugs to treat patients with COVID-19. EurekAlert. News release. January 13, 2022. Accessed January 14, 2022. https://www.eurekalert.org/news-releases/939923