WHO strongly recommends the antiviral drug for pa

Pfizer’s oral antiviral drug (a combination of nirmatrelvir and ritonavir tablets) is strongly recommended for patients with non-severe covid-19 who are at highest risk of hospitalization, such as unvaccinated, elderly or immunocompromised, with a lack of additional vaccination as a risk factor to be taken into account, according to a group of international experts in The BMJ today.

Experts say nirmatrelvir/ritonavir is likely a superior choice for these patients because it can prevent more hospitalizations than alternatives, has fewer potential risks than the antiviral drug molnupiravir, and is easier to administer than intravenous options such as remdesivir and antibody treatments.

However, they advise against its use in low-risk patients, as the benefits are insignificant. And they make no recommendations for patients with severe or critical covid-19, as there are currently no nirmatrelvir/ritonavir trial data for this group.

Their recommendation is based on new data from two randomized controlled trials involving 3,100 patients.

In these trials, moderate-certainty evidence showed that nirmatrelvir/ritonavir reduced hospital admissions (84 fewer admissions per 1,000 patients), low-certainty evidence suggested no important difference in mortality, and evidence of high certainty suggested little or no risk of adverse effects leading to drug discontinuation. .

In the same guideline update, the WHO also makes a conditional (weak) recommendation to use the antiviral drug remdesivir for patients with non-severe covid-19 at high risk of hospitalization.

This is based on new data from five randomized controlled trials involving 2,700 patients and replaces a previous recommendation against remdesivir treatment in all patients with covid-19, regardless of disease severity.

The group noted that antiviral drugs should be administered as early in the course of illness as possible, and recognized some cost and resource implications that may make it difficult for low- and middle-income countries to access, also noting that access to these drugs is linked to access to diagnostic tests for SARS-CoV-2, especially for those targeting the early phase of the disease.

There is also uncertainty about the risk of resistance emerging, they add.

Today’s recommendations are part of a living guideline, developed by the World Health Organization with methodological support from the MAGIC Evidence Ecosystem Foundation, to provide reliable advice on the management of covid-19 and help physicians to make better decisions with their patients.

Living guidelines allow researchers to update pre-reviewed and peer-reviewed evidence summaries as new information becomes available.

Today’s advice adds to previous conditional recommendations for the use of molnupiravir in high-risk patients with non-severe covid-19 and for the use of sotrovimab or casirivimab-imdevimab (monoclonal antibody treatments ) in some patients; and against the use of convalescent plasma, ivermectin and hydroxychloroquine in patients with covid-19, regardless of disease severity. For patients with severe covid-19, WHO strongly recommends corticosteroids, with the addition of IL-6 receptor blockers or baricitinib.


Notes for Editors
Rapid recommendations: a living WHO guideline on drugs for covid-19
Log: The BMJ

Funding: Nothing

Link to the Academy of Medical Sciences press release tagging system: http://press.psprings.co.uk/AMSlabels.pdf

Embargoed link to the directive: http://press.psprings.co.uk/bmj/april/WHOguideline.pdf
Public link once the embargo is lifted: https://www.bmj.com/content/370/bmj.m3379

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