WHO updates its guidance on treatments for COVID-19

The World Health Organization has updated its Therapeutics and COVID-19: living guideline with the most up-to-date recommendations for the treatment of patients with COVID-19.

The fourteenth version, published by The BMJ, incorporates the latest clinical trial evidence for existing and new therapies. It also takes into account the emerging SARS-CoV-2 variants and subvariants that are changing the role of therapeutics.

Updates to the guideline include a recommendation against the use of a new antiviral (VV116) for patients with COVID-19 except in clinical trials, regardless of illness severity.

There is a recommendation against the use of the antiviral drug nirmatrelvir-ritonavir (Paxlovid) in patients with non-severe COVID-19 at high and moderate risk of hospital admission.

And recommendations against the use of antiviral drugs remdesivir and molnupiravir for patients with non-severe COVID-19 who are at moderate and low risk of hospital admission. Instead, the treatment is suggested for patients at high risk of admission.

There is also a strong recommendation against the use of ivermectin for patients with non-severe COVID-19. This accompanies already existing advice against the use of ivermectin in patients with severe or critical COVID-19, except in clinical trials.

There is also a new treatment benefit threshold of 1.5% (down from 6%), a reduction in the risk of hospital admission for people with non-severe COVID-19. This reflects changes in the virulence and transmissibility of circulating SARS-CoV-2 variants and sub-variants, and with changes in immunity related to global vaccinations, which have led to lower baseline risks of severe illness and death for most patients with non-severe COVID-19.

Patients are also now stratified into three distinct risk categories – low, moderate, and high risk of hospital admission – to help doctors more accurately assess whether an individual is at risk, and tailor treatment accordingly.

An interactive decision support tool is available to accompany this guidance.

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