Two new drugs have now been strongly recommended for patients with severe or critical Covid-19 by a group of international experts.
Two new drugs have been pushed forward by the World Health Organisation (WHO) as a means of treating patients with severe or critical Covid-19.
As cases numbers around the world surge, bolstered by the more transmissible Omicron variant, the WHO Guideline Development Group of international experts have strongly receommnded the drug baricitinib to be used in combination with corticosteroids.
Baricitinib, also known as a Janus kinase (JAK) inhibitor, is commonly used to treat rheumatoid arthritis.
The experts’ recommendation, published in The BMJ, “is based on moderate certainty evidence that [the drug] improves survival and reduces the need for ventilation, with no observed increase in adverse effects”.
“The GDG inferred that almost all well informed patients with severe or critical Covid-19 would choose to receive baricitinib due to the likely reduction in mortality, and moderate certainty evidence of little or no increase in serious adverse events,” they noted.
The advice is based on new evidence from seven trials that involved more than 4000 patients with mild, severe and critical Covid-19 infection.
Interleukin-6 (IL-6) inhibitors, another arthritis drug, has similar effects and could also be used in the place of baricitinib, with the team recommending a decision be made based on cost, availability, and clinician experience.
The GDG also put forward another monoclonal antibody drug (casirivimab-imdevimab), but noted “there was insufficient data to recommend one monoclonal antibody treatment over another” and their effectiveness against new variants like Omicron is not yet known.
Monoclonal antibodies are proteins made in a lab that mimic the way the immune system fights viruses.
“In non-severely ill patients, casirivimab-imdevimab probably reduces the risk of hospitalisation and duration of symptoms (both moderate certainty); however, the absolute benefit will be trivial in absolute terms for all but those at highest risk, for whom the intervention should be reserved,” the GDG said.
“Typical characteristics of people at highest risk include lack of vaccination, older people, or those with immunodeficiencies or chronic diseases such as diabetes.”
The recommendations come after WHO chief Tedros Adhanom Ghebreyesus warned Omicron, while less severe, “remains a dangerous virus, particularly for those who are unvaccinated”.
“We must speed up our efforts to expand production, remove trade barriers, and share doses to vaccinate 70 per cent of populations in ALL countries by mid-2022. #VaccinEquity will save countless lives,” he wrote on Twitter.
Covid-19 Technical Lead at the WHO, Maria Van Kerkhove, also pointed out that “as Omicron enters and circulates among vulnerable populations, we will see increase in hospitalisations and deaths”.
“So please treat this virus as seriously as it needs to be treated,” she added.
The Australian Federal Government secured access to 500,000 treatment courses of Pfizer’s Covid-19 oral antiviral drug last October, to be used in combination with the protease inhibitor drug ritonavir, subject to regulatory approval by the Therapeutic Goods Administration (TGA).
The treatment is pegged to reduce the severity or onset of illness in adults who contract or have been exposed to the virus, and is set to be available in Australia at some point this year.
In December, Pfizer said the pill, named Paxlovid, showed near 90 per cent efficacy in preventing hospitalisations and deaths in high-risk patients.
Lab data at the time also suggested the drug retains its effectiveness against the Omicron variant.