Major Update to the COVID-19 Treatment Guidelines

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

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 Panel added a new section entitled Special Considerations in People Who Are Immunocompromised. This section covers methods of preventing SARS-CoV-2 infection and discusses key considerations for clinicians who are managing patients with COVID-19 who are immunocompromised.
  • The Panel also added 3 new sections that focus on the therapeutic management of COVID-19 in children: Pediatric Clinical Management Summary, Therapeutic Management of Nonhospitalized Children With COVID-19, and Therapeutic Management of Hospitalized Children With COVID-19. Because there are currently no results available from clinical trials that evaluated the treatment of COVID-19 in children, and because data from observational studies are limited, the Panel’s recommendations for children are based largely on safety and efficacy data from clinical trials in adults. The recommendations take the child’s risk of disease progression into consideration.
  • Special Considerations in Children was revised to include recent epidemiologic data on COVID-19 and information on the risk factors for severe COVID-19 in children.
  • Clinical Spectrum of SARS-CoV-2 Infection now includes information regarding breakthrough SARS-CoV-2 infections in people who are vaccinated against COVID-19. It also includes updated epidemiologic and clinical information on persistent symptoms and other conditions after acute COVID-19.
  • The Panel updated Prevention of SARS-CoV-2 Infection to include 2 new revisions to the Food and Drug Administration (FDA) Emergency Use Authorization (EUA) for tixagevimab plus cilgavimab (Evusheld). The updates include a warning about the potential risk of cross-hypersensitivity between COVID-19 vaccines and Evusheld and a new recommendation for repeat dosing of tixagevimab 300 mg plus cilgavimab 300 mg every 6 months, as authorized by the updated EUA.
  • Therapeutic Management of Nonhospitalized Adults With COVID-19 briefly discusses the recent case reports of viral rebound, with or without recurrence of symptoms, after a course of ritonavir-boosted nirmatrelvir (Paxlovid) has been completed. This section also reviews recent observational data showing that corticosteroids confer no benefits and may potentially cause harm in patients with COVID-19 who do not require supplemental oxygen.
  • The Panel revised Therapeutic Management of Hospitalized Adults With COVID-19 based on recent clinical trial data on the use of remdesivir or baricitinib in hospitalized patients with COVID-19. The Panel’s recommendations are categorized by a patient’s disease severity and specific clinical scenario. The Panel has also updated the rationale for these recommendations.
  • Kinase Inhibitors: Janus Kinase Inhibitors and Bruton’s Tyrosine Kinase Inhibitors references the recent approval of baricitinib by the FDA for the treatment of COVID-19 in hospitalized adults who require supplemental oxygen, noninvasive ventilation, mechanical ventilation, or extracorporeal membrane oxygenation. Minor revisions have been made to the Panel’s rationale for the use of kinase inhibitors for the treatment of COVID-19. A new clinical data table summarizes the results of key randomized controlled trials.

For more details on these updates, please see What’s New in the Guidelines on the COVID-19 Treatment Guidelines website.