WHO strongly advises against antibody drugs to treat COVID-19

The antibody drugs sotrovimab and casirivimab-imdevimab are no longer recommended for patients with COVID-19, according to a WHO Guideline Development Group of international experts. The antibody drugs work by binding to the SARS-CoV-2 spike protein, neutralising the virus’s ability to infect cells.

The experts’ strong recommendation, published in The BMJ, 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, the 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 7643 patients, showing 13 fewer deaths per 1000 patients with severe COVID-19 taking remdesivir, but 34 more deaths per 1000 patients with critical COVID-19 taking the drug. 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 the conditional recommendation for severe COVID-19.

The 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.

The new recommendations are part of a living guideline, developed by the WHO 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.

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