Q&A on COVID-19 therapeutics
The WHO Regional Office for Europe spoke to Dr Dina Pfeifer, Medical Officer in the Infectious Hazard Management team of WHO/Europe, to learn more about COVID-19 therapeutics, how they work and what role they can play in combatting the disease.
1. What are therapeutics and how are they helpful in the treatment of COVID-19?
Therapeutics in the context of COVID-19 are the drugs used to treat patients with the disease, and they serve 2 main purposes.
- Some are specifically intended for relieving symptoms (for example, cough, fever, headache) in those already suffering severe COVID-19.
- Others, such as antiviral medicines, are designed to be administered during the early stages of the disease to reduce the chances of the virus multiplying and to help prevent the onset of more severe illness in people who are most at risk of this happening. Applied at the right time, these therapeutics could help reduce the need for hospital treatment altogether and so relieve pressures on health systems.
2. How safe and effective are therapeutics for treating COVID-19 patients?
All new medicines undergo rigorous testing for safety and efficacy through clinical trials before they are authorized for use. Numerous randomized controlled trials are currently underway to study how these products perform in a relatively small number of selected individuals over a certain period of time before they can be considered for wider use. The results of these trials then guide our recommendations as to the instances and manner in which these drugs should be used. Safety monitoring continues even after national regulatory authorities have granted marketing authorizations for new drugs to ensure that any rare side effects can be picked up.
3. How does WHO decide on its recommendations for therapeutics?
The WHO Guideline Development Group (GDG), made up of a panel of global experts, frontline providers and patient partners, meets regularly to review evidence from international clinical trials. The GDG then develops practice guidelines containing recommendations for the use of therapeutics to treat patients with COVID-19 of any severity. These guidelines then undergo peer review by another set of clinicians and the Guideline Review Committee prior to publication.
4. What are the main types of therapeutics available and how do they work?
There are several groups of therapeutics used in the treatment of COVID-19.
- Interleukin-6 (IL-6) receptor blockers and Janus kinase (JAK) inhibitors are monoclonal antibodies (laboratory-made identical antibody molecules) that control the body’s inflammatory response to infection in severe or critical patients, and are administered together with corticosteroids.
- Antivirals are medicines that help to stop the virus from replicating and are effective when given as soon as symptoms are seen and diagnosis is confirmed, that is, within 5 days. They are primarily used in people at increased risk of severe disease, for example, patients with certain underlying chronic diseases.
- Lastly, there are antiviral monoclonal antibodies, which stick on the virus and make it easily recognizable to the immune system so it gets inactivated. These are intended for use within 5 days of symptom onset in people at high risk of severe disease, and specifically for those who are likely to have a poor response to vaccines due to another health condition or therapy.
5. What therapeutics are currently on the market?
Some therapeutics were already on the market before the pandemic began and were being used to treat a range of other conditions, for example, corticosteroids and IL-6 receptor blockers. Antiviral monoclonal antibodies have been available since 2020 and have received marketing authorizations in a number of countries. Many of the current therapeutics are intended for use by specific population groups, and in many circumstances are being used under special oversight provisions in order to gain more information on their safety and effectiveness, particularly with regard to drug interactions or potential for the development of virus resistance.
6. Are therapeutics as effective against the Omicron variant?
Some antiviral monoclonal antibodies are less effective against Omicron because they were initially developed in response to previous COVID-19 variants. Antivirals are likely to maintain effectiveness against Omicron, although monitoring of their effectiveness is essential. Anti-inflammatory medicines work just as well for severe and critical cases caused by Omicron as by other COVID-19 variants.
7. Can antivirals be used as an alternative to vaccines?
No, prevention is always better than cure. Even if proven safe and effective, these drugs will not be alternatives to vaccines. WHO-approved vaccines protect most people from severe disease and death. Drugs are important tools for helping people who have fallen sick, but is it still better not to be sick in the first place because of the risks of acquiring severe illness and possible long-term health consequences.
8. Could antivirals help end the pandemic?
Antivirals are yet another tool in our toolkit for combatting SARS-CoV-2 infection and reducing the burden of COVID-19 on communities and health systems. Vaccines, however, are our primary method for preventing serious illness. And as with vaccines, it is important that we see equitable distribution of therapeutics when they become available, so they should be made available and affordable to all countries.
9. Where is the best place to find out more information on therapeutics?
It is important to access information from trusted sources, such as WHO, that have the knowledge, expertise and latest data to be able to make sound judgements on the safety and efficacy of therapeutics. A link to the latest information on COVID-19 therapeutics is included below.