Cape Town - Global health authority the World Health Organization has recommended the drug baricitinib (a type of drug known as a Janus kinase (JAK) inhibitor, also used to treat rheumatoid arthritis) for patients with severe or critical Covid-19 in combination with corticosteroids, according to a press statement on Thursday.
According to a WHO Guideline Development Group of international experts in the BMJ, their strong recommendation is based on moderate certainty evidence that it improves survival and reduces the need for ventilation, with no observed increase in adverse effects.
The WHO experts noted that baricitinib has similar effects to other arthritis drugs called interleukin-6 (IL-6) inhibitors, so when both are available they suggest choosing one based on cost, availability and clinician experience. It is not recommended to use both drugs at the same time, said WHO.
However, experts advise against the use of two other JAK inhibitors (ruxolitinib and tofacitinib) for patients with severe or critical Covid-19 because low certainty evidence from small trials failed to show benefit and suggested a possible increase in serious side effects with tofacitinib.
In the same guideline update, WHO also made a conditional recommendation for the use of the monoclonal antibody sotrovimab in patients with non-severe Covid-19, but only in those at highest risk of hospitalisation, reflecting trivial benefits in those at lower risk.
A similar recommendation was made by WHO for another monoclonal antibody drug (casirivimab-imdevimab). The experts also note that there is insufficient data to recommend one monoclonal antibody treatment over another and acknowledge that their effectiveness against new variants like Omicron is still uncertain, said WHO.
As such, they say guidelines for monoclonal antibodies will be updated when additional data becomes available.
The WHO's recommendations are based on new evidence from seven trials involving over 4,000 patients with non-severe, severe, and critical Covid-19 infection.
They are part of a living guideline developed by WHO with the methodological support of MAGIC Evidence Ecosystem Foundation, to provide trustworthy guidance on the management of Covid-19 and help doctors make better decisions with their patients.