The World Health Organization (WHO) has updated its guidelines for the treatment of COVID-19 patients, adding hospitalization risk categories to help doctors tailor treatment and recommendations for a new antiviral specifically designed to fight the disease.
The new rules released Thursday night include detailed recommendations for other medications depending on whether patients with non-severe cases of COVID-19 are at low, moderate or high risk of hospitalization.
The rules also adjust hospitalization risk thresholds, which could also make it easier for other people with non-severe COVID-19 to receive medications to treat their infection.
The threshold for determining whether it is worth prescribing a drug to a patient with a mild case has been lowered from 6 cents of relief in hospitalizations to 1. 5 cents of relief.
The standards also address drugs that are recommended by the WHO, adding new warnings about ivermectin.
This is the fourteenth update to the guidelines, which have evolved over the more than three and a half years as the clinic of the virus, as well as the virus itself, evolves.
One of the new updates is the treatment efficacy threshold to reduce the risk of hospitalization, which will be considered for patients with non-severe COVID-19.
The guideline development organization first deduced that a drug would need to exceed a threshold of at least a guaranteed six percent relief in the risk of hospitalization to even be considered prescribed to someone with a non-severe case of COVID-19. This means that if a patient had asked about a remedy she had heard about and it only guaranteed a 5% relief from the risk of hospitalization, doctors would not have prescribed it.
Under the new guidelines, the WHO states that if a drug achieves at least 1. 5% absolute relief in the risk of hospitalization, this can still be considered as “significant relief” for patients with non-severe COVID-19, and can be considered as a treatment.
This replacement is due to “increased availability and confidence in their protection profiles,” the rules say.
This doesn’t mean that all non-severe COVID-19 patients will get a remedy that passes this newly lowered threshold, just that the remedy no longer has to cross such a high bar to be considered by doctors.
This reassessment of the treatment benefit threshold is accompanied by an update to the definition of hospitalization risk.
If you have a severe case of COVID-19, hospitalization is likely an issue, but those with non-severe cases will likely end up in the hospital, depending on their risk factors.
While the previous rules only knew about high and low threats, the updated rules now add a moderate threat category. The purpose is to help doctors focus treatment where it will have the greatest effect to keep patients out of the hospital.
Most patients with non-severe COVID-19 are at low risk, their risk of hospitalization is 0. 5 percent.
Patients with non-severe COVID-19 have a moderate (three percent) risk of hospitalization if they meet one or more of those conditions: being over 65 years old, obesity, diabetes, and/or chronic cardiopulmonary diseases. , chronic kidney or liver disease, active cancer, other people with disabilities, and people with comorbidities related to chronic diseases.
Patients with non-severe COVID-19 have the highest risk of hospitalization (six percent) if they have been diagnosed with immunodeficiency syndrome or are receiving immunosuppressants due to an organ transplant or autoimmune disease.
The WHO’s definition of severe COVID-19 includes people with symptoms of pneumonia, severe respiratory distress, and/or blood oxygen saturation below 90%, while severe cases include conditions in which a patient requires life-saving measures due to problems. such as septic infection, shock syndrome, or acute respiratory distress.
Guidelines for the treatment of severe cases of COVID-19 did not require an update in this new edition, however, many drugs have obtained updated recommendations for use in non-severe cases of COVID-19.
Nirmatrelvir is a protease inhibitor drug that prevents viral replication of SARS-CoV-2, the virus that causes COVID-19. It is given to patients with COVID-19 in mixture with ritonavir, an HIV protease inhibitor that complements the effects of nirmatrelvir.
“The (guideline progression group) concluded that nirmatrelvir/ritonavir represents an excellent option over other medications when they can be taken and in patients in whom drug-to-drug interactions are not problematic,” the report says, adding that it was found to be more effective than molnupiravir. , an antiviral drug.
It is the only medication that is primarily used in patients with non-severe COVID-19 who are at increased risk of hospitalization.
The benefits are thought to be largely negligible for other people at low risk of hospitalization.
Remdesivir, an antiviral drug originally developed to treat hepatitis C, has been the subject of studies throughout the pandemic and many are pinning their hopes on it as a treatment. At the beginning of the pandemic, its use was discouraged in certain conditions, as studies did not show a statistically significant effect on patients.
That replaced in 2022, when WHO will conditionally remdesivir, especially for non-severe COVID-19 patients at higher risk of hospitalization.
In this update, WHO adds recommendations for low and low groups.
The use of remdesivir in low-risk patients may simply “exacerbate disparities in physical fitness through significant resources for negligible benefit,” according to the report, adding that it does not lead to significant discounts in hospitalizations and has “little or no impact” on mortality.
Molnupiravir, an antiviral similar to remdesivir, would likely be an option for those who cannot tolerate other medications. However, the WHO notes that there is “residual uncertainty” about the possible long-term harms of its use, adding fears that it could also contribute to the emergence of new variants of COVID-19.
The use of several other medications for patients with non-severe COVID-19 is covered in the guidelines, but did not require an update in this new edition. These come with systemic corticosteroids (conditionally discouraged for any patient with non-severe COVID-19). ), fluvoxamine (conditionally discouraged in a clinical trial), sotrovimab (strongly discouraged for any patient with non-severe COVID-19), and colchicine (strongly discouraged for any patient with non-severe COVID-19).
In this Sept. 10, 2021 file photo, a syringe of ivermectin, a drug used to kill worms and other parasites, rests on the box it was packed in, in Olympia, Washington. Warren, archive)
When COVID-19 emerged in late 2019 and temporarily spread around the world in 2020, researchers immediately began investigating which existing drugs could be repurposed to treat the virus. But Chinese researchers have also begun to devise a treatment aimed in particular at combating COVID-19, for which they presented the first studies in 2021.
Since VV116 was created in particular to combat COVID-19, studies comparing its effectiveness are still new.
It is an oral antiviral drug that induces the termination of the RNA strand to interfere with the spread of the virus. Although the WHO notes that it “does not appear to be related to an accumulation of adverse effects,” there are still doubts According to the agency, there is not enough knowledge to present it at this stage.
Only one randomized controlled trial officially evaluated its efficacy by comparing it with Paxlovid. Although the trial found that VV116 was not inferior to Paxlovid, no deaths were recorded in the entire trial, making it difficult to assess whether the drug itself had any effect. In the prevention of mortality, the WHO said. There was also no placebo control organization in the trial.
The updated guidance reflects that WHO strongly advises against the use of VV116 in patients with COVID-19, regardless of the severity of their illness, as part of a clinical trial.
Despite the widespread use of ivermectin, a drug approved for use in humans to treat parasitic infections such as river blindness, it is still recommended for use in COVID-19 patients in clinical settings, according to WHO guidelines.
But the WHO is now also cautious against its use in other people with a non-severe form of COVID-19, including in the context of research.
New studies that have emerged since 2021 have reduced uncertainty about whether it is appropriate to continue randomized controlled trials comparing the use of ivermectin in other people with non-severe COVID-19, the WHO says.
This knowledge presents a “very low probability of benefit”, either because of the studies that have been tested or also because of the “lack of biological basis for any effect of ivermectin on the virus”. Essentially, it is scientifically unlikely that an effect has occurred, and it has not been proven.
Ivermectin is also discouraged in certain situations in study settings for severe COVID-19 cases.
“The use of ivermectin risks diverting attention and resources from potentially favorable care such as nirmatrelvir/ritonavir, remdesivir and molnupiravir, as well as supportive care interventions,” the WHO says, adding that this risks causing shortage of medicines for other people with problems. Ivermectin is designed to combat its antagonists.
According to the WHO, the use of hydroxychloroquine, lopinavir-ritonavir, casirivimab and imdevimab in patients with COVID-19 is strongly discouraged.
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