WHO Says These 2 Drugs can Help Fight COVID: What to Know

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  • The World Health Organization (WHO) has revised its guidelines to strongly recommend the use of two drugs against COVID-19.
  • They recommend an enzyme blocker called baricitinib and a monoclonal antibody treatment called sotrovimab.

As highly infectious Omicron variant COVID-19 renders many key treatments ineffective, a World Health Organization (WHO) panel has recommended using two more drugs against the virus.

The WHO guidelines, recently published in the British Medical Journal (BMJ), strongly recommend the use of baricitinib as an alternative to interleukin-6 (IL-6) receptor blockers, in combination with corticosteroids, for people experiencing “severe or critical” COVID-19.

Baricitinib is an oral drug often used to treat rheumatoid arthritis. It works by blocking certain enzymes that can lead to inflammation.

The WHO also gave “conditional recommendation” for using the monoclonal antibody drug sotrovimab in patients with non-severe COVID-19 and restricted its use for those at highest risk of hospitalization.

Baricitinib can help calm the immune system

Baricitinib was granted emergency use authorization by the Food and Drug Administration last July to treat hospitalized COVID-19 patients 2 years and older who need treatments that include supplemental oxygen or a ventilator.

The WHO experts noted that baricitinib has similar effects to IL-6 blockers, and when both are available, healthcare professionals should choose based on cost, availability, and clinician experience.

Joan Kapusnik-Uner, PharmD, and vice president of Clinical Content at First Databank (FDB), explained that IL-6 receptor blockers are a drug that blocks a protein called cytokine, which is produced as part of our immune response.

In some people with COVID-19, the immune system can launch a “cytokine storm” that can be dangerous for the patient.

She added that it also can activate “B cells where it importantly results in increased antibody production.”

According to WHO, these recommendations are based on evidence from 7 trials involving over 4,000 patients experiencing non-severe, severe, and critical COVID-19.

“WHO is in discussions with manufacturers to secure global supply capacity and equitable and sustainable access to the newly recommended therapeutics,” the WHO wrote in a statement.

Sotrovimab has ‘full activity’ against variants, expert says

Kapusnik-Uner told Healthline that sotrovimab “is a recombinant human monoclonal antibody (mAbs) given by itself as a single IV infusion and was originally identified in 2003 from a SARS-CoV survivor.”

The WHO also conditionally recommended sotrovimab and another monoclonal antibody drug combination called Regeneron for non-severe COVID-19 at the highest risk of hospitalization.

According to the drugmaker Regeneron, this antibody cocktail is designed to mimic the action of a well-functioning immune system by using “very potent antibodies to neutralize the virus.”

Kapusnik-Uner confirmed that sotrovimab is effective against current COVID-19 variants of concern.

“It does not appear to have reduced efficacy against variants, including current Delta or Omicron variants,” said Kapusnik-Uner. “A conditional recommendation for sotrovimab in patients with non-severe illness reflects substantial reduction in risk of hospitalization in those at higher risk.”

Two COVID-19 drugs no longer recommended by WHO

Experts developing the revised WHO guidelines examined two other drugs used for severe and critical COVID-19 — ruxolitinib, which targets inflammation, and the arthritis treatment tofacitinib.

“Given their uncertain effects, WHO made a conditional recommendation against their use,” the organization wrote.

According to Kapusnik-Uner, new information that includes evolving evidence and patient results has been gathered in an ongoing manner.

“The ‘certainty of evidence’ was recently re-rated as very low for these two drugs, primarily due to serious concerns regarding data quality or imprecision,” she said.

Kapusnik-Uner explained that small trials failed to demonstrate differences in “outcomes of interest,” which included mortality, mechanical ventilation, and hospital length of stay.

WHO recommendations part of a ‘living guideline’

The new recommendations are part of the WHO’s eighth version of its living guideline developed to provide guidance on managing COVID-19 and to help healthcare professionals make better decisions for patients.

According to WHO experts, living guidelines are helpful in fast-moving research areas like COVID-19 because they allow researchers to update “previously vetted and peer-reviewed” evidence summaries as new data becomes available.

They anticipate that guidelines for these treatments will be updated when that data becomes available.

The bottom line

The World Health Organization (WHO) has revised its guidelines to strongly recommend using two drugs against COVID-19.

They recommend an enzyme blocker called baricitinib and a monoclonal antibody treatment called sotrovimab.

The organization also recommended against using ruxolitinib and tofacitinib because further investigation showed low certainty of evidence for these drugs.

Experts say that sotrovimab shows “full activity” for current COVID-19 variants of concern. The WHO recommendation for its use in higher-risk patients with non-severe illness reflects the drug’s effectiveness at reducing hospitalizations for this group.

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