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Explain: How two drugs recently recommended by the WHO work against Covid




World Health Organization (WH0) has recommended two drugs, baricitinib and sotrovimab, for the treatment of Covid-19.


Baricitinib, which is also used to treat rheumatoid arthritis, is “strongly recommended” for patients with severe or critical Covid-19 in combination with corticosteroids. It is part of a class of drugs called Janus kinase inhibitors (JAKs) that suppress immune system overstimulation. It is an oral medication and offers an alternative to other arthritis medications called Interleukin-6 receptor blockers, recommended by the WHO in July 2021.

Sotrovimab, developed by GlaxoSmithKline with US partner Vir Biotechnology Inc., is an investigative monoclonal antibody for use in treating coronavirus-induced conditions. The WHO has conditionally recommended its use for the treatment of mild or moderate Covid-19 in patients who are at high risk of hospitalization. These include patients who are older, are immunocompromised and have underlying conditions such as diabetes, hypertension and obesity, and are unvaccinated. The US Food and Drug Administration (FDA) has also approved an Emergency Use Authorization (EUA) for therapy for the treatment of mild to moderate Covid-19 in patients over 12 years of age.

How they work

Baricitinib, an immunomodulator, is an alternative to tocilizumab: each of these drugs is given to patients who have severe Covid-19, who are clinically advanced with steroids, and who have high inflammatory markers.

Basically, during the severe phase of Covid-19 there is an inflammation that causes severe disease. This is mediated by some inflammatory markers which are then inhibited by Baricitinib, said Dr Sanjay Pujari, a member of the ICMR Covid-19 national task force.

Infectious disease experts said they have used baricitinib since the publication of the COV BARRIER study on the drug. During the wave of Delta infections, there was a lack of tocilizumab and baricitinib was an alternative medicine. Both have different mechanisms of action, but studies have shown mortality benefits if used with steroids in patients with serious Covid-19 disease, Dr Pujari said.

Rheumatologist Dr Arvind Chopra said Olumiant (baricitinib) is a prescription drug used to treat adults with moderate to severely active rheumatoid arthritis. Its ability to inhibit inflammation is also clearly shown as an antiviral drug. However, doctors are advised not to recommend in mild to moderate cases, he said.

The casirivimab-imdevimab antibody cocktail is not active against the Omicron variant while sotrovimab can be used in mild diseases with Delta and Omicron patients at risk of high progression, said Dr Amit Dravid, infectious disease consultant.

Availability in India

Baricitinib is cheap and widely available. It is given to control hyperinflammation, which usually starts between day 7 and 14. The patient starts breathing and it is time to use steroids and add tocilizumab. In case there is an increase in hospital admissions, there is an alternative, baricitinib, which is widely available, Dr Dravid said.

Sotrovimab is not available in India. However, experts said that since Omicron now accounts for the majority of infections, the monoclonal antibodies currently available should only be used if there is clear evidence that the person is infected with the Delta variant.

What does the recommendation mean

The latest WHO recommendations form the eighth update of the WHO Living Guidelines on Therapy and Covid-19. They are based on evidence from seven trials involving over 4000 patients with non-severe, severe, and critical Covid-19.

According to Prof K Srinath Reddy, president of the India Public Health Foundation, approval will be given by the national regulator who may consider the recommendation of trusted national agencies like the WHO.

Baricitinib has long been recommended in the US and Europe in their guidelines.

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