The antibody drugs sotrovimab and casirivimab-imdevimab are not recommended for patients with covid-19, the WHO Guidelines Development Group made up of international BMJ experts says today.
These drugs work by binding to the thorny SARS-CoV-2 protein, neutralizing the virus’s ability to infect cells.
Today’s strong recommendation supersedes previous conditional recommendations for its use and is based on evidence emerging from laboratory studies that are unlikely to work against currently circulating variants, such as omicron.
After evaluating all the evidence, the committee ruled that nearly all informed patients would not choose to receive sutrovimab or cacerifimab-imdivimab.
In the same guidance update, WHO provides a conditional recommendation for the use of the antiviral drug remdesivir in patients with severe COVID-19, and a conditional recommendation against its use in critically ill COVID-19 patients.
These recommendations are based on the results of five randomized trials involving 7,643 patients, showing 13 fewer deaths per 1,000 severe COVID-19 patients taking remdesivir, but another 34 deaths per 1,000 critical COVID-19 patients taking the drug. These new trial data provided enough reliable evidence to demonstrate benefits in patients with severe covid-19, but not critical covid-19. The committee considered the benefits of remdesivir to be modest and with moderate certainty for key outcomes such as mortality and mechanical ventilation, which led to a conditional recommendation.
The World Health Organization also advises that three drugs used to treat arthritis – the IL-6 receptor blocker tocilizumab or sarilumab and the JAK inhibitor baricitinib – can now be combined, in addition to corticosteroids, in patients with severe or critical COVID-19 disease.
This advice is based on new, high-certainty experimental evidence confirming the survival benefit of baricitinib with little or no serious adverse events when administered with corticosteroids and IL-6 receptor blockers.
However, the committee acknowledges some of the cost and resource implications associated with these drugs, which they say may exacerbate health inequalities.
Today’s recommendations are part of a living guide, developed by the World Health Organization with methodological support from the MAGIC Evidence Ecosystem Foundation, to provide up-to-date and trustworthy guidance on managing the coronavirus and help clinicians make better decisions with their patients.
Live guidelines are useful in fast-moving areas of research such as covid-19 because they allow researchers to update summaries of peer-reviewed evidence as new information becomes available.
Previously, the World Health Organization made a strong recommendation for the use of nirmatrelvir and ritonavir, and a conditional recommendation for molnupiravir for high-risk patients with non-severe covid-19. The World Health Organization advises against the use of ivermectin and hydroxychloroquine in patients with COVID-19, regardless of the severity of the disease.
Agarwal, A.; et al. (2022) WHO Living Guide to Coronavirus Drugs. BMJ. doi.org/10.1136/bmj.m3379.