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WHO Living Guideline Updated for Drug Treatment of COVID-19

FRIDAY, Jan. 14, 2022 -- The Janus kinase (JAK) inhibitor baricitinib is strongly recommended for patients with severe or critical COVID-19, and sotrovimab is conditionally recommended for nonsevere COVID-19, according to the updated World Health Organization living guideline on drugs for COVID-19, published online Jan. 13 in The BMJ.

Arnav Agarwal, M.D., from McMaster University in Hamilton, Ontario, Canada, and colleagues updated the living guideline and presented the eighth version relating to the role of drugs in treatment of patients with COVID-19. The evidence base for therapeutics is increasing, and the results from numerous randomized controlled trials (RCTs) completed recently are included.

The authors added new recommendations for JAK inhibitors based on three RCTs (2,659 participants), two RCTs (475 participants), and one RCT (289 participants) for baricitinib, ruxolitinib, and tofacitinib, respectively. A recommendation was also added for sotrovimab (monoclonal antibody) based on one RCT (1,057 participants), which was completed before the emergence of the omicron variant. Baricitinib is strongly recommended as an alternative to interleukin-6 receptor blockers, in combination with corticosteroids, in patients with severe or critical COVID-19. Conditional recommendations are made against the use of ruxolitinib and tofacitinib for severe or critical COVID-19. Sotrovimab is conditionally recommended for patients with nonsevere COVID-19, restricted to those with the highest risk for hospitalization.

"More data are required to ascertain whether efficacy against the omicron variant will be maintained at the studied doses of monoclonal antibodies, and recommendations will be updated when additional data becomes available," the authors write.

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