WHO strongly advises against antibody treatments for COVID-19 patients

The antibody drugs sotrovimab and casirivimab-imdevimab are not recommended for patients with COVID-19, says a WHO Guideline Development Group of international experts in The BMJ.

These drugs work by binding to the SARS-CoV-2 spike protein, neutralising the virus's ability to infect cells.

Today's strong recommendation replaces previous conditional recommendations for their use and is based on emerging evidence from laboratory studies that these drugs are not likely to work against currently circulating variants, such as omicron.

After weighing up all the evidence, the panel judged that almost all well informed patients would not choose to receive sotrovimab or casirivimab-imdevimab.

In the same guideline update, WHO makes 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 patients with critical COVID-19.

These recommendations are based on results from five randomised trials involving 7,643 patients, showing 13 fewer deaths per 1,000 patients with severe COVID-19 taking remdesivir, but 34 more deaths per 1,000 patients with critical COVID-19 taking the drug.

These new trial data provided sufficiently trustworthy evidence to demonstrate benefits in patients with severe COVID-19, but not critical COVID-19. The panel considered the benefits of remdesivir to be modest and of moderate certainty for key outcomes such as mortality and mechanical ventilation, resulting in a conditional recommendation.

WHO also advises that three drugs used to treat arthritis - the IL-6 receptor blockers tocilizumab or sarilumab and the JAK inhibitor baricitinib - may now be combined, in addition to corticosteroids, in patients with severe or critical COVID-19.

This advice is based on new high-certainty trial evidence confirming a survival benefit for baricitinib with little or no serious adverse events when given in combination with corticosteroids and IL-6 receptor blockers.

However, the panel acknowledges some cost and resource implications associated with these drugs, which they say could exacerbate health inequities.

Today's recommendations are part of a living guideline, developed by the World Health Organization with the methodological support of MAGIC Evidence Ecosystem Foundation, to provide up to date, trustworthy guidance on the management of COVID-19 and help doctors make better decisions with their patients.

Living guidelines are useful in fast moving research areas like COVID-19 because they allow researchers to update previously vetted and peer reviewed evidence summaries as new information becomes available.

Previously, WHO has made a strong recommendation for use of nirmatrelvir and ritonavir, and a conditional recommendation for molnupiravir for high-risk patients with non-severe COVID-19. WHO advises against the use of ivermectin and hydroxychloroquine in patients with COVID-19 regardless of disease severity.

Agarwal A, Rochwerg B, Lamontagne F, Siemieniuk RA, Agoritsas T, Askie L, Lytvyn L, Leo YS, Macdonald H, Zeng L, Amin W, da Silva ARA, Aryal D, Barragan FAJ, Bausch FJ, Burhan E, Calfee CS, Cecconi M, Chacko B, Chanda D, Dat VQ, De Sutter A, Du B, Freedman S, Geduld H, Gee P, Gotte M, Harley N, Hashimi M, Hunt B, Jehan F, Kabra SK, Kanda S, Kim YJ, Kissoon N, Krishna S, Kuppalli K, Kwizera A, Lado Castro-Rial M, Lisboa T, Lodha R, Mahaka I, Manai H, Mendelson M, Migliori GB, Mino G, Nsutebu E, Preller J, Pshenichnaya N, Qadir N, Relan P, Sabzwari S, Sarin R, Shankar-Hari M, Sharland M, Shen Y, Ranganathan SS, Souza JP, Stegemann M, Swanstrom R, Ugarte S, Uyeki T, Venkatapuram S, Vuyiseka D, Wijewickrama A, Tran L, Zeraatkar D, Bartoszko JJ, Ge L, Brignardello-Petersen R, Owen A, Guyatt G, Diaz J, Kawano-Dourado L, Jacobs M, Vandvik PO.
A living WHO guideline on drugs for covid-19.
BMJ. 2020 Sep 4;370:m3379. doi: 10.1136/bmj.m3379. Update in: BMJ. 2020 Nov 19;371:m4475. Update in: BMJ. 2021 Mar 31;372:n860. Update in: BMJ. 2021 Jul 6;374:n1703. Update in: BMJ. 2021 Sep 23;374:n2219. Erratum in: BMJ. 2022 Apr 25;377:o1045. PMID: 32887691.

Most Popular Now

Xenpozyme™ (olipudase alfa-rpcp) approved by FDA a…

The U.S. Food and Drug Administration (FDA) has approved Xenpozyme™ (olipudase alfa-rpcp) for the treatment of non-central nervous system (non-CNS) manifestations of acid...

FDA grants Breakthrough Therapy Designation to Pfi…

Pfizer Inc. (NYSE:PFE) today announced that its investigational Group B Streptococcus (GBS) vaccine candidate, GBS6 or PF-06760805, received Breakthrough Therapy Designat...

Malaria booster vaccine shows durable high efficac…

Researchers from the University of Oxford and their partners have today reported new findings from their Phase 2b trial following the administration of a booster dose of ...

Research reveals widespread use of ineffective COV…

Monoclonal antibodies are laboratory-designed treatments tailor-made to fight specific infections. In early 2021, the U.S. Food & Drug Administration issued emergency use...

Strict COVID lockdowns in France improved cardiova…

A new paper in European Heart Journal - Digital Health, published by Oxford University Press, indicates that social-distancing measures like total lockdown have a measura...

Efficacy, cash and more will increase booster shot…

The more effective the COVID-19 booster, the more likely people are to get it, according to new Cornell research. And they are more likely to accept the booster shot with...

U.S. clinical trial evaluating antiviral for monke…

A Phase 3 clinical trial evaluating the antiviral tecovirimat, also known as TPOXX, is now enrolling adults and children with monkeypox infection in the United States. St...

Stem cell-gene therapy shows promise in ALS safety…

Cedars-Sinai investigators have developed an investigational therapy using support cells and a protective protein that can be delivered past the blood-brain barrier. This...

Novartis invests in early technical development ca…

Novartis today announced it is investing in next-generation biotherapeutics with the creation of a fully integrated, dedicated USD 300m scientific environment that will b...

Drug turns cancer gene into "eat me" fla…

Tumor cells are notoriously good at evading the human immune system; they put up physical walls, wear disguises and handcuff the immune system with molecular tricks. Now...

Mucosal antibodies in the airways protect against …

High levels of mucosal antibodies in the airways reduce the risk of being infected by omicron, but many do not receive detectable antibodies in the airways despite three ...

Pfizer and BioNTech receive positive CHMP opinion …

Pfizer Inc. (NYSE: PFE) and BioNTech SE (Nasdaq: BNTX) announced a 30-µg booster dose of their Omicron BA.4/BA.5 bivalent-adapted COVID-19 vaccine (COMIRNATY® Original/Om...