On 21 April 2022, the World Health Organization updated its COVID-19 treatment guidelines in the British Medical Journal (BMJ).
Image source: https://doi.org/10.1136/bmj.m3379
Currently, for patients diagnosed with COVID-19, the WHO recommends the following interventions:
Mild patients (no signs of progression to severe or critical illness):
Strongly recommended: Pfizer oral paxlovid (ritonavir tablets/nematvir tablets); weakly recommended or conditionally recommended: MERCK oral drug Molnupiravir, antibody drugs Sotrovimab, remdesivir (Remdesivir), regenerative meta cocktail therapy REGEN-COV (Casirivimab and Imdevimab); weak opposition or conditional opposition: ivermectin, glucocorticoids Strong objections: convalescent plasma in convalescent patients, hydroxychloroquine, protease inhibitor lopinavir / ritonavir.
Severe patients (oxygen saturation
Strongly recommended: glucocorticoids, IL-6 blockers, baricitinib; weakly recommended or conditionally recommended: regenerative meta cocktail therapy REGEN-COV (Casirivimab and Imdevimab); weakly opposed or conditionally opposed: JAK inhibitors (ruxolitinib and tofacitinib), ivermectin, convalescent plasma for convalescent patients; strong opposition: hydroxychloroquine, protease inhibitor lopinavir// Ritonavir.
Critical illness (need for life support, ARDS, sepsis, shock):
Strongly recommended: glucocorticoids, IL-6 blockers, baricitinib; weakly recommended or conditionally recommended: regenerative meta cocktail therapy REGEN-COV (Casirivimab and Imdevimab); weakly opposed or conditionally opposed: JAK inhibitors (ruxolitinib and tofacitinib), ivermectin, convalescent plasma for convalescent patients; strong opposition: hydroxychloroquine, protease inhibitor lopinavir// Ritonavir.
In this update, WHO said that Pfizer's oral antiviral drug Paxlovid is highly recommended for the treatment of patients with mild or moderate COVID-19 who are at high risk of hospitalization.
In addition, the WHO updated the recommendations for the treatment of Gilead's antiviral remdesivir to conditionally recommend remdesivir to non-critically ill patients at high risk of hospitalization. Replaces the previous recommendation that remdesivir was not recommended conditionally to patients with any degree of COVID-19. In addition, based on new evidence, recommendations for the use of remdesivir in severely ill and critically ill patients are also being updated.
WHO highly recommends Paxlovid for the treatment of mild and moderate COVID-19 patients with the highest risk of hospitalization, calling it by far the best treatment option for high-risk patients. This is based on two randomized controlled trials of Paxlovid involving 3078 patients. The data showed an 85% reduction in the risk of hospitalization for patients in the high-risk group.
However, Janet Diaz, WHO's head of clinical management, said: "This treatment (Paxlovid) is not a substitute for vaccination. It simply offers another treatment option for those at high risk of being infected. High-risk patients are those with underlying chronic diseases, immunocompromised people, or unvaccinated people."
The use of Paxlovid also faces some challenges. Given that it needs to be taken in the early stages of the disease to be effective, getting a quick and accurate test is critical to identifying an infected person. Paxlovid can also interact with many common drugs, thus complicating its use. In addition, the use of Paxlovid for pregnant, lactating women or children has not been studied.
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