- WHO issued a strong recommendation for the use of baricitinib as an alternative to interleukin-6 (IL-6) receptor blockers, or monoclonal antibodies, in combination with corticosteroids, in patients with severe or critical COVID-19
- The agency issued a conditional recommendation against the use of monoclonal antibodies ruxolitinib and tofacitinib for patients with severe or critical COVID-19.
- A conditional recommendation was also issued for the use of sotrovimab, a type of monoclonal antibody, in patients with non-severe COVID-19 but who pose a high risk of hospitalization.
A drug commonly used to treat rheumatoid arthritis has been given the green light for the treatment of severe or critical COVID-19 infections.
When used in conjunction with corticosteroids, baricitinib was shown to improve patient survival and reduce the need for ventilation, announced a World Health Organization (WHO) Development Group of international experts on Jan. 13, 2022. Treatment did not result in an increase of adverse effects, added the group.
The findings are a result of seven trials that included more than 4,000 patients with mild, severe, and critical COVID-19 infection. Severe cases are considered patients with confirmed COVID-19 infection who are also experiencing an oxygen level of less than 90% when breathing without assistance, as well as exhibiting signs of pneumonia and severe respiratory distress. Critical patients require life-sustaining treatment for conditions like acute respiratory distress syndrome, sepsis, and septic shock.
Baricitinib is a type of drug known as an Janus kinase (JAK) inhibitor and was shown to have similar effects as other arthritis drugs called interleukin-6 (IL-6) inhibitors, or monoclonal antibodies. When used in combination with corticosteroids, baricitinib was shown to be more effective than IL-6 inhibitors.
“Baricitinib and IL-6 receptor blockers have similar effects; when both are available, choose one based on issues including cost and clinician experience,” wrote researchers in the peer-reviewed journal, British Journal of Medicine.
Two other JAK inhibitors, ruxolitinib and tofacitinib, were not found to be as effective as baricitinab, with the latter likely increasing serious side effects. As such, the agency issued a conditional recommendation against the use of either.
Corticosteroids, also known as steroids, are a type of anti-inflammatory drug that was previously recommended for severe and critical cases, along with monoclonal antibodies including IL-6 receptor blockers, casirivimab, and imdevimab. The panel added that until more information is available, it cannot recommend one monoclonal antibody treatment over another, nor can it address their effectiveness when it comes to new variants like omicron. (WHO still recommends against the use of remdesivir, convalescent plasma, hydroxychloroquine, and lopinavir-ritonavir. Ivermectin is recommended against except in the use of clinical trials.)
The “living guidelines,” which change and evolve as more information becomes available, were published on Jan. 13, 2022. They replace previous guidelines set forth on Dec. 6, 2021.
“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,” wrote WHO in a news release.
We also have archived the guidelines in their entirety below:
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Agarwal, Arnav, et al. “A Living WHO Guideline on Drugs for Covid-19.” BMJ, vol. 370, Sept. 2020, p. m3379. www.bmj.com, https://doi.org/10.1136/bmj.m3379.
“Are 2 Common Drugs ‘Game Changers’ in Fight Against COVID-19?” Snopes.Com, https://www.snopes.com/news/2020/03/25/chloroquine-covid-19/. Accessed 12 Jan. 2022.
Commissioner, Office of the. “Coronavirus (COVID-19) Update: FDA Authorizes Monoclonal Antibodies for Treatment of COVID-19.” FDA, 23 Nov. 2020, https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-monoclonal-antibodies-treatment-covid-19.
“Did Japan Halt COVID-19 Vax Rollout Due to Ivermectin Success?” Snopes.Com, https://www.snopes.com/fact-check/japan-ivermectin-covid-vaccine/. Accessed 12 Jan. 2022.
“Interleukin-6 Inhibitors.” COVID-19 Treatment Guidelines, https://www.covid19treatmentguidelines.nih.gov/therapies/immunomodulators/interleukin-6-inhibitors/. Accessed 12 Jan. 2022.