The World Health Organization (WHO) has recommended treatment with the combination of two monoclonal antibodies (casirivimab and imdevimab) for two groups of high-risk patients with Covid-19 in its latest living guidelines published in The BMJ.¹ 

“Living guidelines are useful in fast moving research areas like Covid-19 because they allow researchers to update previously vetted and peer reviewed evidence summaries as new information becomes available.”

These high-risk patients include those with non-severe covid-19 at high risk of hospitalization and also seronegative patients with severe or critical Covid-19. The panel has also cautioned that new variants may diminish the effect of casirivimab and imdevimab.

The combination of casirivimab + imdevimab has been shown to reduce the odds of hospitalization and symptom duration in older persons, those who are unvaccinated or immunosuppressed. Reduction in mortality and need for mechanical ventilation in seronegative patients was observed in the RECOVERY trial with this combination.

These new recommendations have been made by the WHO Guideline Development Group (GDG), a panel of international experts and patients and are in addition to its earlier recommendations of interleukin (IL)-6  receptor blockers (tocilizumab or sarilumab) and systemic corticosteroids in patients with severe and critical covid-19.

The WHO strongly recommends against the use of ivermectin, hydroxychloroquine, lopinavir-ritonavir in patients with covid-19, regardless of disease severity. It makes a conditional recommendation against systemic corticosteroids in patients with non-severe disease and use of remdesivir in hospitalised patients with covid-19.

Reference

1. Rochwerg B, et al. A living WHO guideline on drugs for covid-19. BMJ. 2020 Sep 4;370:m3379. doi: 10.1136/bmj.m3379. Updated.