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July 14
The global medicine box against Covid-19 will leave out two “commonly used, inexpensive” drugs, as the World Health Organization has advised against them.
The antidepressant drug fluvoxamine and the gout drug colchicine are not recommended for patients with mild or moderate Covid-19 because of insufficient evidence of improved important outcomes, and both drugs carry potential harms, a WHO Guideline Development Group (GDG) panel of international experts said in the medical journal The BMJ.
No recommendation was made for either drug in patients with severe or critical illness, given limited or no data, according to a note from the journal. Fluvoxamine and colchicine are commonly used, inexpensive drugs that received considerable interest as potential Covid-19 treatments during the pandemic, the note said.
Trial data
The recommendation against using the drugs “reflects ongoing uncertainty about how the drugs produce an effect in the body, and evidence of little or no effect on survival and other important measures, such as risk of hospital admission and need for mechanical ventilation. There is also a lack of reliable data on Covid-19 related serious harms associated with these drugs.”
The advice against the use of fluvoxamine except in clinical trials was informed by data from three randomised controlled trials (RCTs) involving over 2,000 patients, and the strong advice against colchicine was based on data from seven RCTs involving 16,484 patients.
The WHO’s review panel of global experts included four who have had Covid-19. The panel notedthat none of the included studies enrolled children, so the applicability of the recommendations to children is uncertain. However, they did not see why children with Covid-19 would respond any differently to treatment with fluvoxamine or colchicine, the note said.
The recommendations are part of WHO’s living guideline that allows researchers to update previously vetted and peer reviewed evidence summaries as new information becomes available.
No to plasma, hydroxychloroquine
WHO had earlier recommended the use of nirmatrelvir and ritonavir, besides a conditional recommendation for sotrovimab, remdesivir and molnupiravir for high-risk patients with non-severe Covid-19.
For patients with severe Covid-19, WHO strongly recommends corticosteroids, with the addition of IL-6 receptor blockers or baricitinib, but advises against the use of convalescent plasma, ivermectin and hydroxychloroquine, regardless of disease severity, the note added.
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