Which drugs can be used to treat Covid-19 besides vaccines?

The World Health Organisation (WHO) has recommended two new drugs to treat patients with Covid-19, one for patients with critical disease and another for non-severe cases.

The two newly recommended drugs — baricitinib and sotrovimab — form part of the eighth update of WHO’s living guidelines on therapeutics and Covid-19, and are based on evidence from seven trials involving more than 4,000 patients with non-severe, severe and critical Covid-19.

Baricitinib is a Janus kinase inhibitor, a class of drugs used to treat autoimmune conditions, blood and bone marrow cancers and rheumatoid arthritis. It is an oral drug, used in the treatment of rheumatoid arthritis.

Sotrovimab is a monoclonal antibody drug used for treating mild or moderate Covid-19 in patients at high risk of hospitalisation. This includes patients who are older, immunocompromised, have underlying conditions like diabetes, hypertension and obesity and those who are unvaccinated.

“Studies are ongoing on the effectiveness of monoclonal antibodies against Omicron but early laboratory studies show sotrovimab retains its activity.

“The panel of experts developing the guidelines also looked at two other drugs for severe and critical Covid-19, ruxolitinib and tofacitinib. Given their uncertain effects, WHO made a conditional recommendation against their use,” said the organisation.

What does the Covid-19 committee say about the drugs? 

According to a rapid review published by the national health department, the national essential medicines list committee on Covid-19 therapeutics (NEML MAC) suggested the use of baricitinib but only with conditions.

The committee suggests baricitinib for use in hospitalised patients with confirmed Covid-19 who require oxygen and have at least one raised inflammatory marker on specialist motivation/consultation. 

“This recommendation is conditional on baricitinib being accessible to all eligible public sector patients in SA,” it said. 

“Baricitinib reduced mortality in a single study, and was not associated with an increased risk of adverse events. It is cheaper than tocilizumab, and may be administered orally or via nasogastric tube. However, the committee is concerned cost may result in inequitable access, and there is uncertainty regarding supply.”

A rapid review on sotrovimab has either not been done or released by the department.