Lilly's baricitinib granted US emergency use in COVID-19

Doctors in the US are to get another option to treat COVID-19 after the FDA granted an Emergency Use Authorization (EUA) for Eli Lilly’s baricitinib.

Baricitinib is the active ingredient in Lilly’s rheumatoid arthritis drug Olumiant and is the latest example of a drug being repurposed to combat COVID-19.

Most of the drugs attempt to tackle the inflammation that can cause complications in patients with severe disease.

While not all the attempts to get existing drugs to work in COVID-19 have been successful, the FDA said there is enough evidence to justify the emergency use for baricitinib in adults and children aged over two who are hospitalised with the disease and require oxygen therapy or invasive mechanical ventilation.

This temporary authorisation, which only applies during the COVID-19 crisis, is based on data from the Adaptive COVID-19 Treatment Trial (ACTT-2) conducted by the National Institute of Allergy and Infectious Diseases, part of the government funded National Institutes of Health.

Patients treated with baricitinib in combination with Gilead’s remdesivir had a significant reduction in median time to recovery from eight to seven days (12.5% improvement) compared to remdesivir.

The FDA’s decision came as the World Health Organization has advised against using Gilead’s Veklury (remdesivir) to treat hospitalised patients with COVID-19, no matter how severe their illness, after saying new evidence no longer supports its use.

The update is in contrast to the FDA, which has approved remdesivir to treat patients hospitalised with COVID-19 last month, after it was granted and Emergency Use Authorization earlier in the year.

But in the new guidance published in the BMJ, the WHO’s experts recommend against using remdesivir in non-severe, severe, or critical patients, citing weak evidence.

However the panel said there is strong evidence in favour of using corticosteroids in patients with severe or critical disease.

The latest guidance was produced using a systematic review of latest evidence.

According to the panel of experts who drew up the guideline, the evidence suggests that remdesivir has no important effect on mortality, need for mechanical intervention, time to clinical improvement and other outcomes.

The guidance was triggered by findings of the WHO’s SOLIDARITY trial last month, which reported results treating hospitalised COVID-19 patients with remdesivir, the steroid hydroxychloroquine, and the antiviral combination lopinavir-ritonavir.

Findings of SOLIDARITY diverged from evidence gathered in the US – last month data from the National Institutes of Health-backed ACTT-1 trial study showed Veklury resulted in five days’ faster recovery in patients hospitalised with COVID-19.

There was a non-statistically significant trend towards a reduction in mortality, with the effect being more pronounced in patients who were on low-flow oxygen at baseline.

In a statement, Gilead noted that Veklury has been included in guidelines from the NIH and Infectious Diseases Society of America, as well as in national guidelines in Japan, the UK, and Germany.

Gilead added: “These recommendations are based on the robust evidence from multiple randomised, controlled studies published in peer-reviewed journals that demonstrate the clinical benefits of Veklury, such as significantly faster recovery, which can free up limited hospital resources.

“We are disappointed the WHO guidelines appear to ignore this evidence at a time when cases are dramatically increasing around the world and doctors are relying on Veklury as the first and only approved antiviral treatment for patients with COVID-19 in approximately 50 countries.”