The first drug, baricitinib, is a Janus kinase (JAK) inhibitor, a class of drugs used to treat autoimmune conditions, blood and bone marrow cancer, and rheumatoid arthritis.
According to WHO Guideline Development Groupit is “highly recommended” for patients with severe or critical illness in combination with corticosteroids.
The international panel based their recommendations on “moderate-certainty evidence” that it improves survival and reduces the need for ventilation.
No increase in side effects was observed.
Experts note that it has the same effect as other arthritis medications called interleukin-6 (IL-6) inhibitors. Because of this, when both drugs are available, they suggest choosing the best option based on cost, availability, and physician experience.
Simultaneous use of both drugs is not recommended.
Experts also do not recommend the use of the other two JAK inhibitors (ruxolitinib and tofacitinib) for patients with severe or critical cases of COVID-19 infection.
According to them, trials conducted with these drugs did not show any benefits arising from the use of any of them, and suggested a possible increase in serious side effects when taking tofacitinib.
In the same update WHO makes a conditional recommendation for the use of a monoclonal antibody known as sotrovimab in patients with non-severe cases.
The drug should only be given to patients at the highest risk of hospitalization, they said. In people at lower risk, it showed only “trivial benefits”.
A similar recommendation has been made previously for another monoclonal antibody drug, casirivimab-imdevimab, and experts say there is not enough evidence to recommend one over the other.
For both, effectiveness against newer options like Omicron is still questionable.
The panel will update its recommendations for monoclonal antibodies when more data becomes available.
These recommendations are based on new data from seven studies involving more than 4,000 patients with mild, severe, and critical infections.
Developed by WHO with methodological support from the MAGIC Evidence Ecosystem Foundation, the guide provides sound guidance to help physicians make better decisions about their patients.
The agency says the guidelines are useful in rapidly evolving areas of research because they allow investigators to update summaries of evidence as new information becomes available.
The latest guidance also updates recommendations for the use of interleukin-6 receptor blockers and systemic corticosteroids in patients with severe or critical COVID-19; conditional recommendations for the use of casirivimab-imdevimab (another monoclonal antibody treatment) in selected patients; and against the use of convalescent plasma, ivermectin, and hydroxychloroquine, regardless of disease severity.