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 publication of a major update to the Coronavirus Disease 2019 (COVID-19) Treatment Guidelines.

Key changes in this version of the Guidelines include:

• The Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for vilobelimab, an anti-C5a monoclonal antibody. The EUA allows vilobelimab to be used to treat COVID-19 in hospitalized adults when it is administered within 48 hours of mechanical ventilation or extracorporeal membrane oxygenation. A new section, entitled Vilobelimab, discusses the available clinical data on the use of vilobelimab for the treatment of COVID-19.
• Some patients who are immunocompromised have prolonged, symptomatic COVID-19 with evidence of ongoing SARS-CoV-2 replication despite receiving a course of antiviral therapy. Several sections of the Guidelines were updated to include information on treatment options for these patients.
• In Therapeutic Management of Hospitalized Adults With COVID-19, the Panel clarified the role of remdesivir in patients who are hospitalized and require high-flow nasal canula oxygen or noninvasive ventilation.
• Ritonavir-Boosted Nirmatrelvir (Paxlovid) has been updated to reflect the recent FDA approval of ritonavir-boosted nirmatrelvir. Patients who are immunocompromised may need to receive longer courses of ritonavir-boosted nirmatrelvir. The Panel added a discussion of drug-drug interaction considerations for patients who require extended courses of ritonavir-boosted nirmatrelvir.
• The Panel revised Remdesivir to reflect the FDA’s update to the remdesivir prescribing information. The update allows remdesivir to be used without dose adjustment in patients with an estimated glomerular filtration rate of <30 mL/min, including those on dialysis.
• Special Considerations in People Who Are Immunocompromised includes guidance from the Centers for Disease Control and Prevention (CDC) on the use of COVID-19 vaccines in people who are moderately or severely immunocompromised. This section discusses treatment options for patients who are immunocompromised and have prolonged, symptomatic COVID-19 with evidence of ongoing SARS-CoV-2 replication despite receiving a course of antiviral therapy.
• Special Considerations in Children contains updated data on COVID-19 vaccination and post-COVID conditions in children. In addition, the definition of multisystem inflammatory syndrome in children (MIS-C) was updated to match the new case definition for MIS-C issued by the CDC and the Council of State and Territorial Epidemiologists.
• Therapeutic Management of Hospitalized Children With COVID-19 provides recently published data to support the Panel’s recommendations for the use of anticoagulation in children with COVID-19.
• In Therapeutic Management of Hospitalized Children With MIS-C, Plus a Discussion on MIS-A, the Panel continues to recommend using a combination of intravenous immunoglobulin (IVIG) and low to moderate doses of glucocorticoids for the treatment of MIS-C. The Panel updated this section with recently published observational data that supports the recommendation for using glucocorticoid monotherapy in children with MIS-C, but only if IVIG is unavailable or contraindicated.
• The Corticosteroids section has been divided into 2 sections: Systemic Corticosteroids and Inhaled Corticosteroids. These sections contain reviews of recent studies that used high doses of systemic corticosteroids to treat hospitalized patients with COVID-19 and studies that evaluated the use of inhaled corticosteroids in nonhospitalized patients.
• Antithrombotic Therapy in Patients With COVID-19 includes data from clinical trials on the use of direct oral anticoagulant therapy for venous thromboembolism (VTE) prophylaxis or prevention of disease progression in hospitalized adults with COVID-19. In addition, this section discusses the continuation of VTE prophylaxis after hospital discharge in these patients.

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