WHO strongly recommends antiviral medication for patients with non-severe COVID-19
The oral antiviral medication containing 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 patients, with lack of vaccination as an additional condition . risk factor to consider, says a WHO Guideline Development Group of international experts in The BMJ .
Experts explain that nirmatrelvir/ritonavir probably represents a better option for these patients because it can prevent more hospitalizations than the alternatives, has less potential harm 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 lower-risk patients, since the benefits are trivial. And they do not make any recommendations for patients with severe or critical Covid-19, as there is currently no trial data on nirmatrelvir/ritonavir 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 1000 patients), low-certainty evidence indicated no important difference in mortality, and high-certainty evidence indicated that the The risk of adverse effects leading to drug discontinuation is minimal or absent.
In the same guidance update, the WHO also makes a conditional (weak) recommendation to use the antiviral drug remdesivir for patients with non-severe Covid-19 at increased 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 Covid-19 patients, regardless of disease severity.
The panel noted that antiviral medications should be administered as early as possible in the course of the disease and recognized some cost and resource implications that may hinder access in low- and middle-income countries, and noted, also, that access to these medications is difficult. linked to access to SARS-CoV-2 diagnostic tests, especially for those targeting the early phase of the disease. There also remains uncertainty about the risk of resistance emerging, they add.
Today’s recommendations are part of a living guide, developed by the World Health Organization with the methodological support of the MAGIC Evidence Ecosystem Foundation , to provide reliable guidance on the management of covid-19 and help doctors make better decisions. with his patients. The guidelines allow researchers to update previously vetted and peer-reviewed evidence summaries as new information becomes available.
The guidance adds to previous conditional recommendations for the use of molnupiravir for high-risk patients with non-severe Covid-19 and for the use of sotrovimab or casirivimab-imdevimab (monoclonal antibody treatments) in selected patients; and against the use of convalescent plasma, ivermectin and hydroxychloroquine in patients with covid-19 regardless of the severity of the disease.
For patients with severe Covid-19, the WHO strongly recommends corticosteroids, with the addition of IL-6 receptor blockers or baricitinib.
