From the pandemic, some scientists and scientists began to understand how the disease develops. Others dedicated themselves to immunization and there are already 9 authorized vaccines massively in the world. There were also those who concentrated on the development of specific treatments for patients with the infection. A group of experts collaborating with the World Health Organization reviewed the evidence and today published a study with new recommendations for the use of a drug which was already used for rheumatoid arthritis and to a monoclonal antibody as treatments for COVID-19.
The work is published in the specialized journal The BMJ of the British Medical Association. Researchers from Chile, Colombia, Ecuador, Brazil, United States, China, and United Kingdom, among others. They form the WHO Guidelines Development Group that reviews what are the results of the research on the different treatments on the efficacy and safety to treat COVID-19 and issues its recommendations.
On the one hand, experts evaluated the evidence on the drug baricitinib, which is a type of Janus kinase (JAK) inhibitor drug developed by the Eli Lilly laboratory in the United States. Its action is to reduce the activity of the immune system. Before the pandemic, it was recently authorized to treat patients with rheumatoid arthritis. The expert group strongly recommended the use of baricitinib for patients with severe or critical COVID-19 in combination with corticosteroids.
According to the paper, the strong recommendation is based on moderate-certainty evidence that baricitinib improves patient survival and reduces the need for ventilation, with no observed increase in adverse effects.
Too noted that the drug baricitinib has effects similar to those of other arthritis drugs, which are called interleukin 6 (IL-6) inhibitors. When both drugs are available, they suggested choosing one based on cost, availability and physician experience. “It is not recommended to use both drugs at the same time,” they stressed.
There are already other drugs on the market that are Janus kinase inhibitors. But group of experts advised against for use in severe or critical patients with COVID-19. These are ruxolitinib and tofacitinib. They argued that low-certainty evidence from small trials showed no benefit and suggests a possible increase in serious side effects with tofacitinib if used in COVID-19.
In the same guideline update, WHO experts also made a conditional recommendation for the use of the monoclonal antibody, called sotrovimab, in patients with non-severe COVID-19. It was recommended to indicate it only in those patients with a higher risk of hospitalization.
Before, experts had made a similar recommendation for the monoclonal antibodies casirivimab and imdevimab. On this occasion, the experts pointed out that there is not enough data yet to recommend one treatment with monoclonal antibodies instead of another, and recognize that its efficacy against new variants such as the Omicron variant is still uncertain. For this, they state that the monoclonal antibody guidelines will be updated when more data becomes available.
On December 17, the Vir and GSK companies that developed sotrovimab had reported in a statement that sotrovimab protects against infection with Omicron: “Taking into account recent preclinical data from our own laboratories, as well as those of other independent laboratories, which show that sotrovimab maintains its activity against the Omicron variant, which is spreading rapidly, and against all other currently tested variants of concern and interest, We continue to trust in the fundamental role of sotrovimab and we hope to continue contributing to the fight against this pandemic,” said Dr. George Scangos, from the Vir company.
To make recommendations, were based on evidence from seven trials involving more than 4,000 patients with non-severe, severe, and critical COVID-19 infection. They are part of a living guideline, prepared by the World Health Organization with the methodological support of the MAGIC Evidence Ecosystem Foundation. The guidelines were modified based on the results of the different clinical studies. Relative benefits and harms, values and preferences, and feasibility issues are assessed.
The guidelines released today add to previous ones in which experts recommended the use of interleukin 6 receptor blockers and systemic corticosteroids for patients with severe or critical COVID-19. They made conditional recommendations on the use of the monoclonal antibodies casirivimab and imdevimab in selected patients. They also rejected in the previous recommendations the use of convalescent plasma, ivermectin and hydroxychloroquine in patients with COVID-19, regardless of the severity of the disease.
consulted by Infobae, Ventura Simonovich, vice president of the Argentine Association of Experimental Pharmacology and head of clinical pharmacology at the Hospital Italiano de Buenos Aires, commented on the study published in the journal The BMJ with the recommendations on the drugs baricitinib and sotrovimab. “The usefulness of these drugs lies in the decrease in mortality in the group of hospitalized patients, which globally is made up primarily of people who have not yet been vaccinated against COVID-19.”
The medicines evaluated by the WHO experts “could be used in countries like Argentina. At least baricitinib initially. In the case of the drug sotrovimab, perhaps its primary utility is in people with COVID-19 who are at high risk and who were not vaccinated,” Simonovich said.
“In the case of sotrovimab for high-risk outpatients, the group of experts leaves the indication for a group that is becoming smaller thanks to the progress of the vaccination campaign in the world,” said Simonovich. This is because the COVID-19 vaccines give high protection to reduce the risk of complications if people get the coronavirus. “For sotrovimab, a cost-effectiveness analysis for vaccinated patients may be necessary, since in this population the benefit may be reduced compared to unvaccinated patients,” he added.