Explained: How two drugs newly recommended by WHO work against Covid

Baricitinib, used to treat rheumatoid arthritis, suppresses inflammation; sotrovimab is a monoclonal antibody used for treating conditions created by coronavirus infection

4 min readPuneUpdated: Jan 16, 2022 06:50 AM IST

The recommendations are based on evidence from seven trials involving over 4,000 patients with non-severe, severe, and critical Covid-19. (AP Photo: Petr David Josek/File)

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

The drugs

Baricitinib, which is also used to treat rheumatoid arthritis, has been “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 (JAK) inhibitors that suppress the overstimulation of the immune system. It is an oral drug, and provides an alternative to other arthritis drugs called Interleukin-6 receptor blockers, recommended by WHO in July 2021.

Sotrovimab, developed by GlaxoSmithKline with US partner Vir Biotechnology Inc, is an investigational monoclonal antibody for use in treating conditions caused by coronavirus. The WHO has conditionally recommended its use for treating mild or moderate Covid-19 in patients who are at high risk of hospitalisation. These include patients who are older, are immunocompromised, and have underlying conditions like diabetes, hypertension and obesity, and are unvaccinated. The US Food and Drug Administration (FDA) too has approved an emergency use authorization (EUA) for the therapy for the treatment of mild to moderate Covid-19 in patients above 12 years.

How they work

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

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

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

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

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

Availability in India

Baricitinib is cheap and widely available. It is given to control hyper inflammation, which usually starts between days 7 and 14. “The patient starts becoming breathless and that is the time we use steroids and add tocilizumab. In case there is a spike 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 forms the major proportion of infections, the currently available monoclonal antibodies should be used only if there is clear proof that the person has been infected with the Delta variant.

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What the recommendation means

The latest WHO recommendations form the eighth update of WHO’s living guidelines on therapeutics and Covid-19. They are based on evidence from seven trials involving over 4,000 patients with non-severe, severe, and critical Covid-19.

According to Prof K Srinath Reddy, president of the Public Health Foundation of India, the approval will be granted by the national regulator who may take into consideration the recommendation of credible national agencies like WHO.

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

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Anuradha Mascarenhas

Anuradha Mascarenhas is a Senior Editor at The Indian Express, based in Pune. With a career spanning three decades, she is one of the most respected voices in Indian journalism regarding healthcare, science and environment and research developments. She also takes a keen interest in covering women's issues . Professional Background Education: A gold medalist in Communication and Journalism from Savitribai Phule Pune University and a Master’s degree in Literature. Author: She authored the biography At The Wheel Of Research, which chronicles the life and work of Dr. Soumya Swaminathan, the former Chief Scientist at the WHO. Key Focus: She combines scientific accuracy with storytelling, translating complex medical research into compelling public and human-interest narratives. Awards and Recognition Anuradha has won several awards including the Press Council of India's national award for excellence in journalism under the gender based reporting category in 2019 and the Laadli Media award (gender sensitivity -2024). A recipient of the Lokmat journalism award (gender category-2022), she was also shortlisted for the RedInk awards for excellence in journalism-2021. Her debut book At The Wheel Of Research, an exclusive biography of Dr Soumya Swaminathan the inaugural chief scientist of World Health Organisation was also nominated in the Popular Choice Category of JK Paper AUTHER awards. She has also secured competitive fellowships including the Laadli Media Fellowship (2022), the Survivors Against TB – New Research in TB Media Fellowship (2023) and is part of the prestigious 2025 India Cohort of the WomenLift Health Leadership Journey.” Recent Notable Articles (Late 2025) 1. Cancer & Specialized Medical Care "Tata Memorial finds way to kill drug-resistant cancer cells" (Nov 26, 2025): Reporting on a breakthrough for triple-negative breast cancer, one of the most aggressive forms of the disease. Discipline, diet and purpose; How a 97-year-old professor defies ageing'' (Nov 15, 2025) Report about Prof Gururaj Mutalik, the first Head of Department at Pune's B J Government Medical College who at 97 credits his longevity to healthy habits and a strong sense of purpose. 2. Environmental Health (The "Breathless Pune" Series) Long-term exposure even to 'moderate' air leads to chronic heart, lung, kidney issues" (Nov 26, 2025): Part of an investigative series highlighting that even "safe" pollution levels are damaging to vital organs. "For every 10 µg/m3 increase in PM2.5 level, there was 6-8% jump in medicine sales" (Nov 23, 2025): Using commercial data to prove the direct link between air quality and respiratory illnesses in Pune. 3. Lifestyle & Wellness News "They didn't let cancer, diabetes and heart disease stop them from travelling" (Dec 22, 2025): A collaborative piece featuring survivors who share practical tips for traveling with chronic conditions. At 17, his BP shot up to 200/120 mmHG; Lancet study flags why child and teen hypertension doubled between 2000 and 2020'' (Nov 12,2025)--A report that focusses on 17-year-old-boy's hypertensive crisis and reflects the rising global trend of high blood pressure among children and adolescents. 4. Scientific Recognition & Infrastructure For promoting sci-comm, gender diversity: IUCAA woman prof highlighted in Nature" (Nov 25, 2025): Covering the global recognition of Indian women scientists in gender studies and physics. Pune researchers find a spiral galaxy like the Milky Way from early universe'' (December 3, 2025)- A report on how Indian researchers discovered a massive galaxy that existed when the universe was just 1.5 billion years old , one of the earliest to have been observed so far. Signature Beat: Health, Science & Women in Leadership Anuradha is known for her COVID-19 reportage, where she was one of the first journalists to provide detailed insights into the Covishield and Covaxin trials. She has a dedicated interest in gender diversity in health and science, often profiling women researchers who are breaking the "leaky pipeline" in STEM fields. Her writing style is scrupulous, often featuring interviews with top-tier scientists and health experts from various institutions. ... Read More

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