Anticovid treatments that should no longer be used

In the world, more than 600 million people have been diagnosed with covid-19 since the beginning of the pandemic and over 6.4 million have lost the battle against this virus. To control this public health problem, effective vaccines have been developed and which are applied to 64% of the world’s population and some treatments for people at high risk of this infection were also included.

According to the web portal Infobae, from 2020 to date, at least 5,398 clinical trials of the various drugs have been registered, where their effectiveness and safety have been evaluated individually or in combination with others for covid-19.

Given the risks that some drugs can cause, a group of experts from World Health Organization (WHO) monitors and reviews the results of these studies and clinical trials and updates the “living manual”, which serves as a guide for health authorities and health personnel. Thus, WHO clarifies which drugs should be indicated and which should be avoided because they do not harm patients or because they do not provide treatment benefits covid-19.

Specifically, the eleventh version of the WHO guideline provides some recommendations in severe or critical patients for systemic corticosteroids, such as dexamethasone; interleukin-6 receptor blockers (such as tocilizumab or sarilumab), in combination with corticosteroids; and baricitinib as an alternative to IL-6 receptor blockers, in combination with corticosteroids.

Also the organization gives a conditional recommendation for consumption of cazirivimab-imdevimab drug in severely or critically ill patients with seronegative status when rapid virus genotyping is available and coronavirus infection is confirmed. However, the WHO has warned that the efficacy of this drug is limited when people are exposed to the omicron variant of the coronavirus.

In the meantime, patients with covid-19 who are not in a serious condition but are at risk of hospitalization, the WHO recommends the consumption of nirmatrelvir-ritonavir (known by its brand name Paxlovid), which is available in tablets, under the supervision of a doctor. This drug blocks a natural substance in the body to stop the spread of the coronavirus.

For patients at high risk of requiring hospitalization, conditional recommendations were made to indicate the drugs molnupiravir, sotrovimab, casirivimab-imdevimab when rapid testing is available and infection is confirmed.

In addition to this, It has been clarified that patients with non-severe covid-19 should not use systemic corticosteroids or reconstituted plasma. In patients at low risk of hospitalization, nirmatrelvir-ritonavir should not be administered, and in patients with severe and critical covid-19, convalescent plasma is not recommended.

In turn, the WHO does not recommend use ruxolitinib and tofacitinib, hydroxychloroquine, and lopinavir-ritonavir. Several experts strongly recommended against using ivermectin except in the context of a clinical trial.

“Some doctors are reluctant to switch to proven alternatives. ivermectin and fluvoxamine, in particular, they continue to be widely prescribed despite accumulating evidence showing that both treatments at acceptable doses are not effective for covid-19,” experts say.

Another drug not recommended for use in covid-19 cases is fluvoxamine, used to treat depression, and the use of colchicine in non-critical patients is also not recommended.

In this sense, one of the experts who participated in the preparation of the evidence-based recommendations, Ariel Izkovic, a clinician and consultant of the Pan American Health Organization (PAHO), told Infobae that “antiviral drugs reduce the progression to serious disease. But today, if people have received vaccines, including boosters, the risk of developing a serious condition is so low that those who benefit from the drugs are very few. Therefore, you have to choose them very well because these drugs have a high price“.

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