From the Guidelines
The recommended treatment for COVID-19 in 2025 should prioritize baricitinib as the immunomodulator of first choice for all hospitalized patients who are receiving oxygen therapy, including low- and high-flow, non-invasive and invasive ventilation, based on the most recent and highest quality evidence from placebo-controlled trials. This recommendation is supported by a study published in 2024 in the journal Clinical Microbiology and Infection 1, which analyzed the results of placebo-controlled trials and found that baricitinib is the immunomodulator with the most consistent evidence of a survival benefit for hospitalized patients with COVID-19.
The treatment approach for COVID-19 continues to evolve, and it is essential to consider the most recent guidelines and evidence when making treatment decisions. While older studies, such as those published in 2020 in the BMJ 1, suggested the use of molnupiravir and nirmatrelvir/ritonavir for patients with non-severe COVID-19 at high risk of hospitalization, the more recent evidence from 2024 1 supersedes these recommendations.
Key considerations for COVID-19 treatment in 2025 include:
- The use of baricitinib as the first-line immunomodulator for hospitalized patients requiring oxygen therapy
- Individualized treatment decisions based on patient factors, such as vaccination status, variant exposure, comorbidities, and disease severity
- The importance of consulting the most recent guidelines from major health organizations or healthcare providers for up-to-date recommendations on COVID-19 treatment.
It is crucial to prioritize the results of placebo-controlled trials over open-label trials when making treatment decisions, as the former provides more reliable evidence of treatment efficacy and safety 1. By following this approach, healthcare providers can ensure that patients with COVID-19 receive the most effective and evidence-based treatment available.
From the FDA Drug Label
PAXLOVID is indicated for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adults who are at high risk for progression to severe COVID-19, including hospitalization or death. The recommended treatment for Covid-19 in 2025 is PAXLOVID (nirmatrelvir; ritonavir), which is indicated for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adults who are at high risk for progression to severe COVID-19, including hospitalization or death.
- The recommended dosage for PAXLOVID is 300 mg nirmatrelvir (two 150 mg tablets) with 100 mg ritonavir (one 100 mg tablet) with all 3 tablets taken together orally twice daily for 5 days.
- Initiate PAXLOVID treatment as soon as possible after diagnosis of COVID-19 and within 5 days of symptom onset. 2
From the Research
Covid-19 Treatment in 2025
The recommended treatment for Covid-19 in 2025 is based on various studies that have evaluated the efficacy of different antiviral medications. Some key points to consider are:
- Nirmatrelvir in combination with ritonavir is an antiviral treatment for mild-to-moderate coronavirus disease 2019 (Covid-19) 3.
- The efficacy of nirmatrelvir-ritonavir in patients who are at standard risk for severe Covid-19 or who are fully vaccinated and have at least one risk factor for severe Covid-19 has not been established 3.
- Nirmatrelvir-ritonavir demonstrated a greater risk reduction in hospitalization and death than molnupiravir compared to placebo 4.
- Both nirmatrelvir-ritonavir and molnupiravir need to be started within 5 days of symptoms onset and given for 5 days' duration 4.
Antiviral Medications
Some antiviral medications that have been studied for the treatment of Covid-19 include:
- Nirmatrelvir-ritonavir: This medication has been shown to reduce the risk of hospitalization and death in high-risk patients with Covid-19 5, 6.
- Molnupiravir: This medication has been compared to nirmatrelvir-ritonavir in patients with haematological malignancies and Covid-19, and has been found to have similar efficacy 7.
Key Findings
Some key findings from the studies include:
- Nirmatrelvir-ritonavir reduces the risk of all-cause mortality and hospital admission or death in high-risk, unvaccinated Covid-19 outpatients infected with the Delta variant of SARS-CoV-2 5.
- Nirmatrelvir-ritonavir probably has little or no effect on treatment-emergent adverse events, and probably increases treatment-related adverse events such as dysgeusia and diarrhoea 5.
- Molnupiravir is a plausible alternative to nirmatrelvir-ritonavir for Covid-19 treatment in patients with haematological malignancy 7.
- Nirmatrelvir-ritonavir reduces COVID-19 hospitalization and prevents long COVID in adult outpatients 6.