Thread by @ArnavAgarwalMD

🔥 Our latest @WHO living guidance on drugs for #COVID19:

Severe/critical:
✅steroids, IL-6RB, baricitinib
🔷REGN-COV
🔶other JAK2i, plasma

Non-severe:
🔷molnupiravir, REGN-COV, sotrovimab
🔶steroids
🚫plasma

All:
🔶remdesivir, ivermectin
🚫HCQ, LPV/r

bit.ly/3pAK6Oe

Important considerations/caveats:
✨Choice between baricitinib & IL-6RB for severe/critical COVID-19 depends on availability & clinical/contextual factors.
✨In non-severe illness, molnupiravir, sotrivimab & casirivimab-imdevimab are weakly recommended for those at highest risk.

Some other considerations/caveats:
✨Other JAK2i should be considered for severe/critical illness only if baricitinib is not available.
✨Ivermectin (across severities) & plasma (for severe/critical) should be considered only in the context of a clinical trial.

🌟 This iteration: a new weak/conditional recommendation for molnupiravir in patients with non-severe illness at highest risk of hospitalization, with mitigation strategies.

Treatment reduces hospitalization risk & time to symptom resolution; may have small survival benefit.

🔷 Among patients with non-severe illness, the recommendation is limited to those at highest risk of hospitalization who are likely to derive greatest benefit.

This is considering potential long-term harms (e.g. risk of malignancy) & uncertainty re: identifying highest risk pts.

🌟 This iteration also incorporates two updates to prior recommendations:

1. Conditional recommendations for casirivimab-imdevimab in non-severe & severe/critical COVID-19 now restricted to cases where rapid genotyping is available & confirms susceptible SARS-CoV-2 variant.

🌟 The other change:

2. New trial data has resulted in ongoing evidence review by the guideline panel to update the previous conditional recommendation against remdesivir across severities; update anticipated in next iteration.

A living systematic review & network meta-analysis, led by @RSiemieniuk & @rominabrigpet with contributions from @jessbartoszko, @DenaZera, @AnilaQasim, @Elena_Kum et al, informed recommendations.

Check out the 🔥 website with evidence readily accessible: covid19lnma.com

This work contributes to collaborative living guidance produced by @WHO and the #MAGIC Evidence Ecosystem on drugs to prevent #COVID19, also published via @bmj_latest.

This is an incredible cross-collaborative effort - honoured and lucky to be part of it.

Associated guideline in the @WHO portal: bit.ly/3tlXdqi

Associated guideline in @theMAGICapp: bit.ly/3Gk5ldZ

Associated LNMA: bit.ly/3lIKNnP

Important to recognize the superstar team behind this work:

@Bram_Rochwerg
@RSiemieniuk
@ThomasAgoritsas
@LamontagneFran5
@LisaAskie
@lyubovlytvyn
@drhelmac
@drwagdy
@erlinaburhan
@DrMCecconi
@HeikeGeduld
@PRICE_critcare
@FyezahJehan
@bhwords
@leticiakawano
@arthurkwizera

(continued)
@ProfSKrishna
@KrutikaKuppalli
@tlisboa79
@Gremile
@Nsutebu
@NidaQadirMD
@saniyasbz
@msh_manu
@sebasugarte
@sridhartweet
@VuyisekaDubula
@ananda1958
@DenaZera
@jessbartoszko
@rominabrigpet
@GuyattGH
@diazjv
@PerVandvik

What is in the pipeline? The @WHO portal summarizes therapeutics to come (dot = week of time).

In deciding which therapeutics to cover, WHO considers factors including extent of available evidence, and makes a judgment on whether & when additional evidence may be anticipated.