BMJ: WHO strongly recommends antiviral drugs for non-severe COVID-19 patients

Pfizer's oral antiviral (combination of nirmatrelvir and ritonavir tablets) is strongly recommended for non-severe covid-19 patients at highest risk of hospitalization, such as unvaccinated, older or immunosuppressed patients who lack vaccination is another risk factor to consider, the WHO's international expert guidance development group said today in the British Medical Journal

Experts explained that nirmatrelvir/ritonavir may be a better option for these patients because it may prevent more hospitalizations than other drugs, is less potentially harmful than the antiviral drug molnupirvir, and is less harmful than intravenous drugs ( such as remdesivir and antibody therapy) are easier to manage

However, they are not recommended in lower-risk patients because the benefit is negligible

Their recommendations are 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 1000 patients), low-certainty evidence of no major difference in mortality, and high-certainty evidence of little or no Risk of adverse reactions leading to drug discontinuation

In the same guidance update, WHO also has a conditional (weak) recommendation to use the antiviral drug remdesivir for non-severe COVID-19 patients at highest risk of hospitalization

The conclusion, based on new data from five randomized controlled trials involving 2,700 patients, supersedes the previous recommendation that all covid-19 patients, regardless of disease severity, not be treated with remdesivir

The panel noted that antiviral drugs should be used as early as possible in the early stages of disease, acknowledging some cost and resource implications that could make low- and middle-income countries challenging, noting that, at the same time, access to these drugs is tied to access to SARS-CoV-2 2 Diagnostic tests, especially for those in the early stages of the disease

Uncertainty also remains about the risk of resistance emerging, they add

Today's recommendations are part of a guide to life developed by the World Health Organization, supported by the MAGIC Evidence Ecosystem Foundation methodology, to provide credible guidance on the management of covid-19 and help physicians make better decisions together with their patients

The Living Guidelines allow researchers to update previously reviewed and peer-reviewed summaries of evidence as new information becomes available

Today's guidance complements previous conditional recommendations for the use of molnupirvir in non-severe COVID-19 high-risk patients and the use of sotrovimab or casirivimab-imdevimab (monoclonal antibody therapy) in selected patients; for COVID-19 patients, regardless of severity Convalescent plasma, ivermectin, and hydroxychloroquine should not be used