Major Update to the COVID-19 Treatment Guidelines

Major Update to the COVID-19 Treatment Guidelines

The COVID-19 Treatment Guidelines Panel (the Panel) is pleased to announce the release of a new version of the Coronavirus Disease 2019 (COVID-19) Treatment Guidelines.

Key updates to the Guidelines include:

• The Panel added a new section on the antidiabetic agent Metformin. Based on the results of 2 randomized controlled trials, the Panel recommends against the use of metformin for the treatment of COVID-19 in nonhospitalized patients and hospitalized patients, except in a clinical trial.
• The evidence rating scheme in Guidelines Development has been revised to better reflect the quality of the evidence that supports the recommendations in the Guidelines.
• In Overview of COVID-19, the Panel highlights recent studies that have shown that some racial and ethnic minority groups experience higher rates of COVID-19, subsequent hospitalization, and death in relation to their share of the total U.S. population. Disparities in access to care and receipt of treatment for COVID-19 have also been reported. The Panel recommends that health care providers, health care systems, and payers ensure equitable access to high-quality care and treatment for all patients, regardless of race, ethnic identity, or other minoritized identity or social status.
• Prevention of SARS-CoV-2 Infection was updated to include information on the new bivalent COVID-19 vaccines. In addition, because tixagevimab plus cilgavimab (Evusheld) is the only product authorized for use as SARS-CoV-2 pre-exposure prophylaxis (PrEP), the Panel continues to recommend the use of this combination as PrEP for eligible individuals despite the increasing prevalence of Omicron subvariants that are resistant to tixagevimab plus cilgavimab.
• The Panel recommends remdesivir as the preferred treatment option for patients who cannot take ritonavir-boosted nirmatrelvir (Paxlovid) because of significant drug-drug interactions. However, some treatment facilities may not have the ability to provide a 3-day course of remdesivir intravenous infusions to all eligible patients. The Panel updated Prioritization of Anti-SARS-CoV-2 Therapies for the Treatment of COVID-19 in Nonhospitalized Patients When There Are Logistical Constraints to provide guidance on how best to prioritize patients when logistical constraints prevent remdesivir from being administered to all eligible patients.
• In COVID-19 Convalescent Plasma, the Panel revised the recommendation language for the use of COVID-19 convalescent plasma (CCP) in patients who are immunocompromised. There is currently insufficient evidence for the Panel to recommend either for or against the use of high-titer CCP for the treatment of COVID-19 in hospitalized or nonhospitalized patients who are immunocompromised. However, some Panel members would use CCP to treat an immunocompromised patient with significant symptoms attributable to COVID-19 and with signs of active SARS-CoV-2 replication and who is having an inadequate response to available therapies.

For a full list of updates, please see What's New in the Guidelines on the COVID-19 Treatment Guidelines website.