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The World Health Organization (WHO) has made the move to officially recommend two new drugs to treat patients with COVID-19: an arthritis drug called baricitinib and the monoclonal antibody sotrovimab.
As reported in the BMJ today, the WHO Guideline Development Group of international experts strongly recommends treating people with severe COVID-19 with baricitinib, a janus kinase (JAK) inhibitor also used to treat rheumatoid arthritis.
Sometimes known by its brand name Olumiant, it’s thought the drug's anti-inflammatory properties help prevent the out-of-control inflammatory response often seen in hospitalized patients with critical COVID-19.
The WHO says they’ve seen clear moderate evidence that the drug significantly improves survival from severe infections and reduces the need for ventilation. One trial by Italian scientists, for example, found that COVID-19 patients treated with baricitinib had a significantly better chance of survival when compared to clinically and demographically matched patients not treated with the drug.
“The WHO experts note 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,” the WHO said in a statement via email.
Although baricitinib has only just got the official thumbs up from the WHO, people have been treated with the drug for some time. The US Food and Drug Administration (FDA) issued emergency authorization for baricitinib in combination with remdesivir for the treatment COVID-19 way back in November 2020. In July 2021, the FDA revised its authorization to say that baricitinib can now be used alone.
In the same guideline update, the WHO also makes a conditional recommendation for the use of the monoclonal antibody sotrovimab for people with mild to moderate COVID-19 deemed to be at a high risk of hospitalization.
A monoclonal antibody is a lab-made antibody made by cloning a unique white blood cell. Like most monoclonal antibody treatments for COVID-19, sotrovimab works by binding to the spike protein on the outside of the COVID-19 virus, preventing the virus from entering human cells.
There's some decent emerging evidence that the drug does a good job at preventing hospitalization if it's promptly given to vulnerable people with COVID-19. One clinical trial late last year found that using sotrovimab as an early treatment for high-risk patients with COVID-19 dramatically slashed their odds of being hospitalized and dying.
Once again, the FDA gave emergency authorization to sotrovimab back in May 2021, and the UK followed suit in December 2021, but it's now been given an official recommendation from the WHO.
"Sotrovimab is given by IV infusion over 30 minutes. Side effects are limited to infusion reactions which may rarely include anaphylaxis, and so must be given in a setting where resuscitation facilities are available," Professor Penny Ward, Visiting Professor in Pharmaceutical Medicine at King’s College London, commented in December when the UK gave the drug the green light.
"Perhaps of greater importance, the product was designed to bind to a highly conserved portion of the spike protein, making it less susceptible to mutations. Initial information demonstrates broad activity against most variants," she added.
