The physical space of the MSK Library is permanently closed to visitors as of Friday, May 17, 2024. Please visit this guide for more information.
The physical space of the MSK Library is permanently closed to visitors as of Friday, May 17, 2024. Please visit this guide for more information.
COVID-19 therapeutics have evolved over the course of the pandemic. In early 2020 there were no approved therapies for COVID-19 infections and clinicians were scrambling to find drugs and treatments that worked.
By mid-2020, a handful of treatments were being used including steroids, immunoglobulins, antivirals, anticoagulants, chloroquine/hydroxychloroquine, and convalescent plasma.
As 2021 began, a new landscape emerged, with a variety of monoclonal antibodies approved to treat mild to severe COVID-19 infections, as well as several antiviral drugs approved for COVID-19.
However, Omicron rendered many of these new therapies useless, and within the span of a single year (2022), the FDA pulled its authorization of every available COVID-19 monoclonal antibody.
As of January 26, 2023 there are no longer any monoclonal antibodies authorized by the FDA to treat or prevent COVID-19 infections.
| Therapy | Who | When | How |
|---|---|---|---|
| Paxlovid (Nirmatrelvir with Ritonavir) | Adults, Children 12+ | ASAP, must begin within 5 days of symptom onset | Orally, at home |
| Veklury (Remdesivir) | Adults and Children | ASAP, must begin within 7 days of symptom onset | IV infusion, healthcare facility |
| Lagevrio (Molnupiravir) | Adults | ASAP, must begin within 5 days of symptom onset | Orally, at home |
Patients with COVID-19 who are receiving concomitant medications (e.g., angiotensin-converting enzyme [ACE] inhibitors, angiotensin receptor blockers [ARBs], HMG-CoA reductase inhibitors [statins], systemic or inhaled corticosteroids, nonsteroidal anti-inflammatory drugs, acid-suppressive therapy) for underlying medical conditions should not discontinue these medications during acute management of COVID-19 unless discontinuation is otherwise warranted by their clinical condition.
The COVID-19 antiviral Molnupiravir works by inducing serious mutations in the viral genome of SARS-CoV-2. The risks of this drug causing further viral mutagenesis (new variants) in immunocompromised hosts is still unclear, however clinicians should be aware of the risks when prescribing COVID therapies for immunocompromised patients.
Some people with COVID-19 who are immunocompromised or are receiving immunosuppressive treatment may benefit from a treatment called convalescent plasma. Plasma from donors who have recovered from COVID-19 (regardless of vaccination status) may contain antibodies to SARS-CoV-2 that could help suppress viral replication. In August 2020, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for COVID-19 convalescent plasma (CCP) for the treatment of hospitalized patients with COVID-19. The EUA was subsequently revised. The current EUA limits the authorization to the use of CCP products that contain high levels of anti-SARS-CoV-2 antibodies (i.e., high-titer products) for the treatment of outpatients or inpatients with COVID-19 who have immunosuppressive disease or who are receiving immunosuppressive treatment.
Guidance on the use of convalescent plasma to treat immunocompromised patients with COVID-19
Clinical Infectious Disease, Accepted Manuscript - February 2023
The Panel provides recommendations for managing adult patients with a range of clinical presentations, from outpatients with mild disease to hospitalized patients who need mechanical ventilation or ECMO.
Clinical Management of Children
The Panel’s recommendations for the management of children with COVID-19 or MIS-C are summarized below.
Therapeutic Management of Hospitalized Pediatric Patients With Multisystem Inflammatory Syndrome in Children (MIS-C) - This section outlines the COVID-19 Treatment Guidelines Panel’s (the Panel) recommendations for the therapeutic management of pediatric patients with multisystem inflammatory syndrome in children (MIS-C).