What are the treatment options for Coronavirus disease (COVID-19)?

From the Guidelines

Treatment for COVID-19 should prioritize the use of corticosteroids, such as dexamethasone, and anti-IL-6 receptor monoclonal antibody therapy, as these have been shown to decrease mortality in hospitalized patients 1.

Key Considerations

• For mild cases, rest, hydration, and over-the-counter medications like acetaminophen (Tylenol) or ibuprofen can help manage fever and pain.
• Antiviral medications such as nirmatrelvir/ritonavir (Paxlovid) or remdesivir may be prescribed for those at high risk of severe disease, ideally within 5 days of symptom onset.
• For moderate to severe cases requiring hospitalization, treatment may include oxygen therapy, dexamethasone (6mg daily for up to 10 days), and anticoagulants to prevent blood clots.
• Monoclonal antibody treatments, such as those against anti-spike protein, should be considered for patients at risk of severe COVID-19 course, with symptom onset <5 days or still seronegative 1.

Treatment Options

• Corticosteroids: dexamethasone (6mg daily for up to 10 days) has been shown to decrease mortality in hospitalized patients 1.
• Anti-IL-6 receptor monoclonal antibody therapy: has been shown to decrease mortality in hospitalized patients 1.
• Antiviral medications: nirmatrelvir/ritonavir (Paxlovid) or remdesivir may be prescribed for those at high risk of severe disease, ideally within 5 days of symptom onset.
• Monoclonal antibody treatments: should be considered for patients at risk of severe COVID-19 course, with symptom onset <5 days or still seronegative 1.

Prevention

• Vaccination remains the most effective preventive measure against severe COVID-19 illness.
• Patients should isolate for at least 5 days after symptom onset and continue wearing masks for 5 additional days when around others.

From the FDA Drug Label

VEKLURY is indicated for the treatment of coronavirus disease 2019 (COVID-19) in adults and pediatric patients (birth to less than 18 years of age weighing at least 1. 5 kg) who are [see Clinical Studies (14)]: Hospitalized, or Not hospitalized and have mild-to-moderate COVID-19, and are at high risk for progression to severe COVID-19, including hospitalization or death. ACTEMRA® (tocilizumab) is indicated for the treatment of coronavirus disease 2019 (COVID-19) in hospitalized adult patients who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).

The treatment for Covid-19 includes:

• Remdesivir (IV): for adults and pediatric patients (birth to less than 18 years of age weighing at least 1.5 kg) who are hospitalized or not hospitalized with mild-to-moderate COVID-19 and are at high risk for progression to severe COVID-19 2.
• Tocilizumab (IV): for hospitalized adult patients who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) 3 3.

From the Research

Treatment Options for Covid-19

• Therapeutic anticoagulation can be considered in patients who do not require intensive care and have an elevated risk of thromboembolism 4
• For patients with hypoxemic respiratory insufficiency, prone positioning and an early therapy attempt with CPAP/noninvasive ventilation or high-flow oxygen therapy is recommended 4
• Patients with IgG-seronegativity and, at most, low-flow oxygen should be treated with SARS-CoV-2-specific monoclonal antibodies (at present, casirivimab and imdevimab) 4
• Patients needing no more than low-flow oxygen should additionally be treated with janus kinase (JAK) inhibitors 4
• All patients who need oxygen (low-flow, high-flow, noninvasive ventilation/CPAP, invasive ventilation) should be given systemic corticosteroids 4
• Tocilizumab should be given to patients with a high oxygen requirement and progressively severe COVID-19 disease, but not in combination with JAK inhibitors 4

Hospital Admission and Treatment

• Determination of the indication for the admission of COVID-19 patients to the hospital should involve consideration of age, comorbidities, respiratory rate, and oxygen saturation 5
• Every patient admitted without a recent PCR test should be tested immediately 5
• It is recommended that any COVID-19 patient with hypoxemia (SpO2 <90%) despite being given oxygen, dyspnea, or a high respiratory rate be admitted to intensive care 5
• In the case of hypoxemic respiratory insufficiency, an attempt at treatment with high-flow oxygen or non-invasive ventilation is suggested, while patients with severe hypoxemia/high respiratory rate should undergo intubation and invasive ventilation 5

Pharmacological Treatments

• Remdesivir is the first antiviral agent approved for the treatment of COVID-19, based on results from large clinical trials showing reduction in recovery time, faster clinical improvement, and decrease in time to discharge with remdesivir 6
• Dexamethasone and tocilizumab have demonstrated mortality benefits in large, randomized controlled trials 6
• Monoclonal antibody combinations bamlanivimab/etesevimab and casirivimab/imdevimab received emergency use authorizations for use in non-hospitalized patients with mild-to-moderate COVID-19 at high risk of disease progression 6

Long Covid Treatment

• Current management strategies focus on symptom-based supportive care 7
• Critical considerations include energy conservation strategies and addressing comorbidities and modifiable risk factors 7
• Medication use generally follows standard practice regarding indications and dosing, with extra attention to prioritize patient preference via shared decision-making and cautious use of medications that may improve some symptoms but may worsen other symptoms 7

Outpatient Treatment

• Unvaccinated COVID-19 outpatients with at least one risk factor for a severe disease course may be treated in the early phase of the disease with sotrovimab, remdesivir, or nirmatrelvir/ritonavir 8
• Molnupiravir may also be used for such patients if no other clinically appropriate treatment options are available 8
• Immunosuppressed persons with COVID-19 who are at high risk, and whose response to vaccination is expected to be reduced, ought to be treated with sotrovimab 8