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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

Written by Anuradha Mascarenhas , Edited by Explained Desk | Pune |
Updated: January 16, 2022 6:50:44 am
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.

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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.

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.

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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