WHO advises 2 monoclonal antibodies for severe COVID


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The World Health Organization (WHO) today recommended the use of anti-inflammatory monoclonal antibodies—tocilizumab and sarilumab—alongside corticosteroids for treating patients who have severe or critical COVID-19 infections.

In other global developments, some countries including Indonesia, Vietnam, and Bangladesh, reported new record daily highs for infections, as COVID-19 cases continued to rise in parts of Europe.

Meta-analysis reveals life-saving impact

The WHO's treatment recommendation comes in the wake of a study published today in the Journal of the American Medical Association (JAMA), in which researchers analyzed 27 randomized trials that involved nearly 11,000 patients.

They found that the interleukin-6 antagonists tocilizumab and sarilumab reduced the risk of death and the need for mechanical ventilation. The WHO coordinated the study, which included partners from the United Kingdom.

The investigators found that the drugs were most effective when given with corticosteroids. Hospitalized patients who got one of the drugs along with corticosteroids had a 17% reduction in death compared with corticosteroids given alone. The combination cut the risk of mechanical ventilation or death by 21% compared with corticosteroids alone.

Immune system overreaction is a feature of severe COVID-19 infection, and the two drugs—both initially developed to treat rheumatoid arthritis—were thought to have the potential to inhibit the interleukin-6 cytokines that the immune system generates during those instances. Earlier individual studies were inconclusive, ranging from benefit to no effect to harm.

For the study, the WHO and UK researchers combined data from 27 randomized trials spanning 28 countries. Taken together, the meta-analysis included 6,449 patients who were randomly assigned an interleukin-6 antagonist and 4,481 who received usual care or placebo.

The risk of death within 28 days was lower in those who received the drugs, and outcomes were better in patients who were also treated with corticosteroids. For every 100 patients treated with corticosteroids, 4 more survived. And when the team looked at death and mechanical ventilator outcomes, they found that adding the drugs meant that, for every 100 such patients, 7 more will survive.

Janet Diaz, MD, clinical management lead for the WHO's health emergencies program, said in a King's College London news release that bringing together the results of international trials is one of the best ways to determine which treatments will save lives.

"While science has delivered, we must now turn our attention to access. Given the extent of global vaccine inequity, people in the lowest income countries will be the ones most at risk of severe and critical COVID-19. Those are the people these drugs need to reach," she said.

In a related commentary, two scientists who weren't involved in the study said the treatments are promising for hospitalized patients with progressive disease and substantial oxygen requirements. The authors are Michael Matthay, MD, an acute respiratory disease specialist, and Anne Leutkemeyer, MD, an infectious disease expert, both based at the University of California, San Francisco.

They said questions surround how the drugs compare to other interventions and what threshold to use for using them, though for now, they don't seem destined for widespread use in patients with mild disease or in patients who have been on prolonged mechanical ventilation.

Record COVID in Southeast Asia

Indonesia's daily COVID-19 total rose to a new record high of 31,189 new cases, with a daily record 728 deaths reported, according to Xinhua, China's state news agency. Cases have been reported from all of the country's provinces, though roughly one third of the daily cases are from Jakarta.

The country's surge is overwhelming some hospitals, as well as the supply of oxygen. Dozens of patients reportedly died at a public hospital on the island of Java when the facility ran out of oxygen over the weekend, according to the Washington Post.

Meanwhile, Vietnam yesterday reported 1,102 new cases, the first time the country—known for its strong public health response—has topped 1,000 in a single day, according to Reuters. The country's latest COVID wave started in late April, and though cases have been reported across the country, Ho Chi Minh City accounts for the most, according to the VN Express newspaper.

More global headlines

  • Bangladesh, another country reporting record cases and deaths, announced that it will extend its lockdown until Jul 14, according to Reuters.

  • Japan announced it will extend its quasi state of emergency for Tokyo and three surrounding prefectures through the Olympics owing to rising COVID-19 cases, according to Nikkei Asia.

  • Israel yesterday reported a drop in Pfizer-BioNTech vaccine effectiveness against infections and symptoms amid Delta (B1617.2) variant spread and relaxed restrictions, though it is still highly effective against serious illness. Since Jun 6, efficacy against infection and symptomatic disease declined to 64%, with efficacy against serious illness and hospitalization at 93%, according to the country's health ministry.

  • UK government officials signaled that they will proceed with full reopening on Jul 19, despite rising cases, given the positive impact of vaccination. The country is experiencing a rise in cases without a steep rise in hospitalizations, with infections up 53% over the past week.

  • The global total today rose to 184,394,772 cases, and 3,988,239 people have died from their infections, according to the Johns Hopkins online dashboard.

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