COVID-19 therapeutics - WHO | World Health Organization

THE LATEST ON THE COVID-19 GLOBAL SITUATION& COVID-19 THERAPEUTICS

LAST UPDATE: 7 March 2022CORONAVIRUS

UPDATE

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* Data are incomplete for the current week. Cases depicted by bars; deaths depicted by line

Current global situationCASES REPORTED TO WHO AS OF 7 MARCH 2022

CHECK OUT THE LATEST GLOBAL SITUATION

WHOCoronavirus Disease (COVID-19) Dashboard

• Cases: > 445 million • Deaths: > 5.9 million

https://covid19.who.int/

RECOMMENDATIONS ON COVID-19 THERAPEUTICS

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COVID-19 Clinical CARE Pathway

ConfirmSARS-CoV-2

infection

https://www.who.int/tools/covid-19-clinical-care-pathway

AssessSymptoms, risk factors

and severity

RespondWith appropriate

care and treatment

EvaluateClinical response

and recovery

https://www.who.int/tools/covid-19-clinical-care-pathway


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Recommendations for therapeutics may differ based on the severity of COVID-19

SpO2 = oxygen saturation

https://app.magicapp.org/#/guideline/nBkO1E

Disease severity & definitions

NON-SEVERE SEVERE CRITICAL

Absence of signs of severe or

critical disease

SpO2<90%on room air

Respiratory rate>30 in adults

Raised respiratory rate in children

Signs of severe respiratory distress

Requires lifesustaining treatment

Acute respiratorydistress syndrome

Sepsis

Septic shock

Figure. Three disease severity groups and key characteristics

Caution: The guideline panel noted that the oxygen saturation threshold of 90% to define severe COVID-19 was arbitrary and should be interpreted cautiously when used to define disease severity. For example, clinicians must use their judgment to determine whether a low oxygen saturation is a sign of severity or is normal for a given patient with chronic lung disease. Similarly, a saturation between 90–94% in room air may be abnormal (in patient with normal lungs) and can be an early sign of severe disease, if patient is on a downward trend. Generally, if there is any doubt, the panel suggested erring on the side of considering the illness as severe

Patients with confirmed COVID-19



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WHO treatment recommendations for personswith confirmedCOVID-19

https://www.who.int/publications/i/item/WHO-2019-nCoV-therapeutics-2021.1

*For those with the highest risk of hospitalization, where viral genotyping can confirm a susceptible SARS-CoV-2 variant ** Unless there is clinical suspicion of a bacterial infection*** Except in the context of a clinical trial**** except in the context of a clinical trial for patients with

severe disease

Tocilizumab or SarilumabIL-6 receptor blockers

NON-SEVERE SEVERE CRITICAL

Thromboprophylaxis

Oxygen therapy

Corticosteroids

CorticosteroidsMIS-C in children

Casirivimab and Imdevimab*Monoclonal antibodies - For seronegative status

Antibiotic therapy**

Hydrochloroquine

Lopinavir/Ritonavir

Remdesivir

Ivermectin***

REC

OM

MEN

DED

NO

T R

ECO

MM

END

ED

Casirivimab & Imdevimab*

Convalescent plasma***

Baricitinib - JAK inhibitor

Ruxolitinib or Tofacitinib****

Molnupiravir - Antiviral therapy

Conditional recommendation

Strong recommendation

Sotrivimab



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WHO recommends administering standard thromboprophylaxis in hospitalized COVID-19 patients

TROMBOPROPHYLAXIS

• Coagulopathy *** is common in patients with severe COVID-19, and both venous and arterial thromboembolism have been reported

• Monitor patients with COVID-19, for signs or symptoms suggestive of thromboembolism, such as stroke, deep venous thrombosis, pulmonary embolism or acute coronary syndrome. If these are clinically suspected, proceed immediately with appropriate diagnostic and management pathways

In hospitalized patients with COVID-19, without an established indication for higher dose anticoagulation, WHO recommends administering standard thromboprophylaxis dosing of anticoagulation rather than therapeutic* or intermediate dosing**

* Therapeutic dosing of anticoagulation refers to the dose used for treatment of acute venous thromboembolism; ** Intermediate dosing is commonly interpreted as twice the standard thromboprophylaxis dose

*** Condition where the blood’s ability to form clots is impaired


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WHO recommends immediate administration of supplemental oxygen therapy to any patient with emergency signs

WHO recommends immediate administration of supplemental oxygen therapy to any patient with emergency signs during resuscitation to target SpO2 ≥ 94% and to any patient without emergency signs and hypoxaemia * (i.e. stable hypoxaemic patient) to target SpO2 > 90% or ≥ 92–95% in pregnant women

OXYGEN THERAPY

Photo: WHO


* Low blood oxygen



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WHO recommends the use of systemic corticosteroids for severe COVID-19

WHO recommends using systemic corticosteroids to treat people with severe or critical COVID-19

NOT RECOMMENDED FOR MILD DISEASE

Systemic corticosteroids are not recommended for patients with mild or moderate COVID-19

RECOMMENDED FOR SEVERE DISEASE

Photo: science.thewire.in




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WHO recommends treatment with IL-6 receptor blockers (Tocilizumab or Sarilumab) for patients with severe or critical COVID-19 infection

WHO recommends treatment with Il-6 receptor blockers (Tocilizumab or Sarilumab) for patients with severe or critical COVID-19 infection.

Corticosteroids are strongly recommended in patients with severe and critical COVID-19. WHO recommends that patients meeting these severity criteria should receive both corticosteroids and IL-6 receptor blockers

IL-6 RECEPTOR BLOCKERS




WHO recommends using Baricitinib to treat people with severe or critical COVID-19

Baricitinib is a Janus kinase (JAK) inhibitor that blocks the cytokine pathway. Baricitinib should be administered together with corticosteroids*

An IL-6 receptor blocker (Tocilizumab or Sarilumab) and Baricitinib should be viewed as alternatives

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WHO recommends the treatment with Baricitinibfor severe COVID-19

*in patients with severe or critical COVID-19

Therapeutics and COVID-19: living guideline (who.int)

BARICITINIB



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WHO recommends treatment with Casirivimab -Imdevimab (monoclonal antibodies)

WHO recommends Casirivimab - Imdevimab (neutralizing monoclonal antibodies) conditional to those at highest risk of hospitalization*, and where viral genotyping can confirm a susceptible SARS-CoV-2 variant (i.e.excluding Omicron BA.1)

MONOCLONAL ANTIBODIES

WHO recommends Casirivimab - Imdevimab (neutralizing monoclonal antibodies) conditional to those with seronegative status, and where viral genotyping can confirm a susceptible SARS-CoV-2 variant (i.e. excluding Omicron BA.1)


*people at highest risk include those who are unvaccinated, older people, or those with immunodeficiencies and/or chronic diseases (e.g. diabetes).

Source: NGHS.com

For non-severe COVID-19:

For severe or critical COVID-19:




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WHO recommends treatment with Sotrivimab(monoclonal antibodies)

WHO recommends Sotrivimab (neutralizing monoclonal antibodies) for patients with non-severe COVID-19 (who do not meet criteria for severe or critical infection) conditional to those at highest risk of hospitalization*


For non-severe COVID-19:

*people at highest risk include those who are unvaccinated, older people, or those with immunodeficiencies and/or chronic diseases (e.g. diabetes).




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WHO recommendations for multisystem inflammatory syndrome (MIS-C) in children

In hospitalized children aged 0–18 who meet a standard case definition for MIS-C, WHO suggests using corticosteroids in addition to supportive care (rather than either IVIG* plus supportive care, or supportive care alone)

CORTICOSTEROIDS

In hospitalized children aged 0–18 who meet both a standard case definition for MIS-C and diagnostic criteria for Kawasaki disease, WHO suggests using corticosteroids in addition to standard of care for Kawasaki disease

CORTICOSTEROIDS

**https://cms.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-2*Intravenous immune globulin

WHO case definition of MIS-C**

1. Age 0 to 19 years 2. AND Fever for ≥ 3 days 3. AND Clinical signs of multisystem

involvement (at least two of the following):

• rash, bilateral nonpurulentconjunctivitis, or mucocutaneous inflammation signs (oral, hands, or feet)

• hypotension or shock • cardiac dysfunction, pericarditis,

valvulitis, or coronary abnormalities

• evidence of coagulopathy• acute gastrointestinal symptoms

4. AND elevated markers of inflammation 5. AND no other obvious microbial cause

of inflammation6. AND evidence of SARS-CoV-2 infection

https://cms.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-2


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WHO recommends treatment with Molnupiravir

WHO recommends Molnupiravir (antiviral therapy) for patients with non-severe COVID-19 conditional to those at highest risk of hospitalization*; excluding pregnant and breastfeeding women, and children

ANTIVIRAL THERAPY

*people at highest risk include those who are unvaccinated, older people, or those with immunodeficiencies and/or chronic diseases (e.g. diabetes).** change in the DNA of a cell resulting in a gene mutation

The mechanism of action of Molnupiravir is via damage to the viral genetic information; impact, if any on human genetic material is currently unknown.

As this is a new medicine, there is little safety data. WHO recommends active monitoring for drug safety, along with other strategies to mitigate potential harms (such as avoiding the drug in younger adults). Because of these concerns and data gaps, Molnupiravir should be provided only to non-severe COVID-19 patients with the highest risk of hospitalization.

https://www.who.int/news/item/03-03-2022-molnupiravir


NOT RECOMMENDED FOR MILD OR MODERATE DISEASE*

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WHO does not recommend the use of antibiotic therapy in patients with mild or moderate COVID-19

WHO does not recommend antibiotic therapy or prophylaxis for use in patients with mild or moderate COVID-19; *unless there is clinical suspicion of a bacterial infection

Unless there is clinical suspicion of a bacterial infection




NOT RECOMMENDED FOR ANY LEVEL OF SEVERITY OF DISEASE

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WHO does not recommend use of Hydroxychloroquine, Lopinavir / Ritonavir or Remdesivir for treatment of COVID-19

WHO does not recommend administering Hydroxychloroquine, Lopinavir / Ritonavir or Remdesivir for treatment of COVID-19 for patients of any disease severity

https://www.who.int/publications/i/item/WHO-2019-nCoV-therapeutics-2021.1https://www.who.int/publications/i/item/WHO-2019-nCoV-prophylaxes-2021-1

NOT RECOMMENDED FOR PREVENTION

WHO does not recommend administering Hydroxychloroquine prophylaxis to individuals who do not have COVID-19


https://www.who.int/publications/i/item/WHO-2019-nCoV-prophylaxes-2021-1


NOT RECOMMENDED FOR ANY LEVEL OF SEVERITY OF DISEASE*

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WHO does not recommend use of Ivermectin for the treatment of COVID-19Except in the context of a clinical trial

WHO does not recommend use of Ivermectin in patients with COVID-19; *except in the context of a clinical trial.

This recommendation applies to patients with any disease severity and any duration of symptoms.

A recommendation to only use a drug in the setting of clinical trials is appropriate when there is very low certainty evidence and future research has a large potential for reducing uncertainty about the effects of the intervention and for doing so at reasonable cost




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WHO does not recommend administering convalescent plasma for the treatment of COVID-19

WHO does not recommend administering convalescent plasma for treatment of COVID-19; *except in the context of a clinical trial for patients with severe disease

NOT RECOMMENDED FOR ANY LEVEL OF SEVERITY OF DISEASE

NOT RECOMMENDED FOR ANY LEVEL OF SEVERITY OF DISEASE*

Except in the context of a clinical trial for patients with severe disease




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WHO does not recommend the use of Ruxolitinib or Tofacitinib for the treatment of severe COVID-19

NOT RECOMMENDED FOR SEVERE DISEASE

WHO does not recommend Ruxolitinib and Tofacitinib for patients with severe or critical COVID-19

• Ruxolitinib and Tofacitinib are Janus kinase (JAK) inhibitors

• There is a need for more trial evidence to better inform the recommendations; this is anticipated through ongoing trials for these JAK inhibitors


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Additional resources

• Therapeutics and COVID-19:living guidelineThe Organization’s most up-to-date recommof therapeutics in the

treatment of COVID-19 endations for the use


• Therapeutics and COVID-19:living guideline (MAGICapp)Dynamically updated evidence and recommendations, focusing on

what is new while keeping recommendations within the guidelines


• Drug treatments for covid-19: living systematic review & network meta-analysisComparing the effects of treatments for COVID-19

https://www.bmj.com/content/370/bmj.m2980

• What is the role of drugs in preventing covid-19?https://www.bmj.com/content/372/bmj.n526

• Therapeutics and COVID-19 Therapeutics and COVID-19 WHO webpage

• COVID-19 Clinical management: living guidanceProviding omprehensive, holistic guidance for the optimal

care of COVID-19 patients throughout their illness

https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-1

https://covid-nma.com/living_data/index.php

• Pharmacologic treatments for COVID-19 patientsTreatment comparisons

https://www.who.int/teams/health-care-readiness-clinical-unit/covid-19/therapeutics

• WHO living guideline: Drugs to prevent COVID-19https://www.who.int/publications/i/item/WHO-2019-nCoV-prophylaxes-2021-1



https://www.bmj.com/content/370/bmj.m2980

https://www.bmj.com/content/372/bmj.n526

https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-1

https://covid-nma.com/living_data/index.php

https://www.who.int/teams/health-care-readiness-clinical-unit/covid-19/therapeutics

https://www.who.int/publications/i/item/WHO-2019-nCoV-prophylaxes-2021-1

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COVID-19 protective measuresProtect yourself & others

Cough & sneeze into your elbow

Wear a mask

Keep your distance Wash your hands frequently

Ventilate or open windows Get vaccinated

when it is your turn

www.who.int/epi-win

COVID-19 therapeutics - WHO | World Health Organization

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