COVID-19 Treatment Guidelines Updated

Extensive COVID-19 Treatment Guidelines Updates

The COVID-19 Treatment Guidelines Panel (the Panel) has published a revised version of the Coronavirus Disease 2019 (COVID-19) Treatment Guidelines.

Key updates to the Guidelines include:

• Outpatient Management of Acute COVID-19 has been divided into two sections: General Management of Nonhospitalized Patients With Acute COVID-19 and Therapeutic Management of Nonhospitalized Adults With COVID-19.
• A new figure has been created for Therapeutic Management of Nonhospitalized Adults With COVID-19 to provide guidance on the use of therapeutic agents (e.g., anti-SARS-CoV-2 monoclonal antibodies) based on the patient’s disposition.
• Therapeutic Management of Hospitalized Adults with COVID-19 has been updated to incorporate new recommendations and rationale for using baricitinib in combination with dexamethasone in certain hospitalized patients with COVID-19. The update is based on results from the COV-BARRIER trial. The Panel recommends against the use of baricitinib in combination with tocilizumab (AIII).
• A new section was added to discuss the use of nitazoxanide as an antiviral drug for the treatment of COVID-19. The Panel recommends against the use of nitazoxanide for the treatment of COVID-19, except in a clinical trial (BIIa).
• A new section was added to address the use of granulocyte-macrophage colony-stimulating factor (GM-CSF) inhibitors as immunomodulators for the treatment of COVID-19. Based on the preliminary results from two randomized, placebo-controlled trials investigating otilimab and lenzilumab and a small, randomized, placebo-controlled trial of mavrilimumab, the Panel has determined that there is insufficient evidence to recommend either for or against the use of GM-CSF inhibitors for the treatment of hospitalized patients with COVID-19.
• Chloroquine or Hydroxychloroquine and/or Azithromycin has been updated with new clinical data from multiple trials. The recommendation for using these agents in nonhospitalized patients has been revised, and a recommendation regarding azithromycin monotherapy has been added.
• Colchicine has been updated with the results from an unpublished, randomized, placebo-controlled trial that evaluated the role of colchicine in hospitalized patients with COVID-19. The study showed no difference in 28-day all-cause mortality between patients who received colchicine and those who received usual care. Based on these results, the Panel now recommends against the use of colchicine for the treatment of hospitalized patients with COVID-19 (AI).
• Special Considerations in Pregnancy has been updated to include recent epidemiologic data indicating that some pregnant people may be at increased risk of COVID-19. In general, the therapeutic management of COVID-19 should be the same for pregnant patients as for nonpregnant patients. Developing a treatment plan should involve shared decision making between the patient and the clinical team, with considerations based on the severity of maternal disease and the safety of the medication for the pregnant individual and the fetus. Breastfeeding in the setting of COVID-19 is not contraindicated, and decision-making surrounding feeding breast milk while the patient is receiving therapeutic agents for COVID-19 is addressed. Updates to this section also include safety data on the use of COVID-19 vaccines during pregnancy.

For a complete list of other updated sections and sections under revision, please see What's New in the Guidelines on the COVID-19 Treatment Guidelines website.