What are the primary treatment options for COVID-19?

From the Guidelines

The primary treatment for COVID-19, particularly in patients requiring oxygen therapy, non-invasive ventilation, or high-flow oxygen, should include the combination of glucocorticoids and baricitinib or tofacitinib, as it may decrease disease progression and mortality. This approach is supported by recent studies, including the COV-BARRIER trial, which showed that baricitinib in addition to standard of care (SOC), including glucocorticoids, resulted in decreased all-cause 28-day mortality from 13% to 8% (HR=0·57 [95% CI 0·41–0·78]; p=0·0018) 1.

For patients with mild COVID-19, treatment typically involves supportive care, including rest, hydration, and over-the-counter medications for symptom relief. However, for higher-risk patients or those with more severe disease, antiviral medications like remdesivir or immunomodulators may be necessary. The use of dexamethasone, a glucocorticoid, is also crucial in hospitalized patients with severe disease, as it has been shown to reduce mortality.

Key considerations in COVID-19 treatment include:

• Disease severity: Guides the intensity of treatment, from supportive care for mild cases to more aggressive interventions for severe disease.
• Timing of symptom onset: Influences the decision to use antiviral medications, which are most effective when started early in the course of the disease.
• Patient risk factors: Helps in identifying individuals who may benefit from more aggressive or early intervention to prevent disease progression.

The combination of glucocorticoids with baricitinib or tofacitinib is particularly noteworthy for its potential to decrease disease progression and mortality in patients with COVID-19 requiring oxygen therapy or more intensive respiratory support, as evidenced by the study published in the Annals of the Rheumatic Diseases 1.

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. The recommended dosage for adults and pediatric patients weighing at least 40 kg is a single loading dose of VEKLURY 200 mg on Day 1 via intravenous infusion followed by once-daily maintenance doses of VEKLURY 100 mg from Day 2 via intravenous infusion.

The primary treatment options for COVID-19 include:

• Remdesivir (IV): for hospitalized patients and non-hospitalized patients with mild-to-moderate COVID-19 who are at high risk for progression to severe COVID-19.
• The treatment course should be initiated as soon as possible after diagnosis of symptomatic COVID-19 has been made.
• The recommended total treatment duration for hospitalized patients requiring invasive mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO) is 10 days.
• The recommended treatment duration for hospitalized patients not requiring invasive mechanical ventilation and/or ECMO is 5 days.
• For non-hospitalized patients with mild-to-moderate COVID-19, the recommended treatment duration is 3 days 2.
• Studies have shown that remdesivir can reduce the risk of hospitalization and mortality in non-hospitalized patients with mild-to-moderate COVID-19 who are at high risk for progression to severe COVID-19 2.

From the Research

Primary Treatment Options for COVID-19

The primary treatment options for COVID-19 include:

• Supportive care, such as oxygen therapy and ventilatory support, for patients with severe and critical disease 3, 4
• Symptomatic and optimal supportive care, including oxygenation, anti-coinfection treatments, and ventilation, for critical patients 4
• Treatment with dexamethasone, which has been shown to decrease mortality among patients with severe or critical COVID-19 5, 6
• Combination therapy with baricitinib, remdesivir, and dexamethasone, which has been shown to be effective in treating severe COVID-19 7

Hospital Admission and Intensive Care

• Determination of the indication for hospital admission should involve consideration of age, comorbidities, respiratory rate, and oxygen saturation 5
• Patients with hypoxemia, dyspnea, or a high respiratory rate should 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 Prevention of Thrombosis

• Intensified prophylaxis against thromboembolism may be indicated in the presence of additional risk factors, such as obesity, known thrombophilia, intensive care treatment, or elevated D-dimers 5