High certainty evidence that they improve survival and other important measures
Tocilizumab and sarilumab - both interleukin-6 (IL-6) receptor blockers - are strongly recommended for patients admitted to hospital with severe or critical covid-19 by a WHO Guideline Development Group (GDG) panel of international experts and covid-19 patients in The BMJ today.
Their recommendation is based on new high certainty evidence from several trials including the RECOVERY and REMAP-CAP trials that both drugs have a similar effect on improving survival and the need for mechanical ventilation.
The recommendation is part of a living guideline, developed by the World Health Organization with the methodological support of MAGIC Evidence Ecosystem Foundation, to provide up to date, trustworthy guidance on the management of covid-19 and help doctors make better decisions with their patients.
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.
Tocilizumab and sarilumab are approved for use in rheumatoid arthritis. They block a specific part of the immune system (interleukin 6) that can go into overdrive in some patients with covid-19. Doctors think this might help lessen the body’s inflammatory response to the virus and avert some of the more dire consequences of the disease.
The panel acknowledged that the certainty of evidence for serious adverse events or bacterial and fungal infections are low to very low, and recognised the high cost and resource implications associated with these drugs (they must be given intravenously).
However, they say this strong recommendation “should provide a stimulus to improve global access to these treatments.
In conclusion, the panel judged that almost all well informed patients would want to receive IL-6 receptor blockers for severe and critical covid-19, given that there was high certainty evidence of benefit for mortality and mechanical ventilation, the two most important outcomes for patients.
Today’s guidance adds to previous recommendations, including not to use ivermectin in patients with covid-19, regardless of disease severity; a strong recommendation against the use of hydroxychloroquine in patients with covid-19, regardless of disease severity; and a strong recommendation for the use of systemic corticosteroids in patients with severe and critical covid-19.
Notes for editors
Rapid Recommendations: A living WHO guideline on drugs for covid-19
Journal: The BMJ
Link to Academy of Medical Sciences press release labelling system: https://press.psprings.co.uk/AMSlabels.pdf
Externally peer reviewed? Yes
Evidence type: Clinical practice guideline
Subjects: Drugs for covid-19
Authors available via BMJ / WHO Media Relations:
Emma Dickinson, BMJ Media Relations, London, UK
If you are a journalist needing to speak to an expert, please click here.Browse our Expert Media Panel
Latest coverage of BMJ in the national and international mediaSEE BMJ IN THE NEWS
If you are a journalist who would like to receive our press releases, please provide your details.GET THE LATEST PRESS RELEASES
Email the UK media relations team for more information.CONTACT US TODAY