Materiały źródłowe

• #1

  https://link.springer.com/article/10.1007/s11908-021-00769-8

  Rapidly evolving treatment paradigms of coronavirus disease 2019 (COVID-19) introduce challenges for clinicians to keep up with the pace of published literature and to critically appraise the voluminous data produced. This review summarizes the clinical evidence from key studies examining the place of therapy of recommended drugs and management strategies for COVID-19. […] The global magnitude and duration of the pandemic have resulted in a flurry of interventional treatment trials evaluating both novel and repurposed drugs targeting various aspects of the viral life cycle. Additionally, clinical observations have documented various stages or phases of COVID-19 and underscored the importance of timing for the efficacy of studied therapies. […] Since the start of the COVID-19 pandemic, many observational, retrospective, and randomized controlled studies have been conducted to guide management of COVID-19 using drug therapies and other management strategies. Large, randomized, or adaptive platform trials have proven the most informative to guide recommended treatments to-date.

• #2 Therapeutic strategies for COVID-19: progress and lessons learned | Nature Reviews Drug Discovery

  https://www.nature.com/articles/s41573-023-00672-y

  The coronavirus disease 2019 (COVID-19) pandemic has stimulated tremendous efforts to develop therapeutic strategies that target severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and/or human proteins to control viral infection, encompassing hundreds of potential drugs and thousands of patients in clinical trials. So far, a few small-molecule antiviral drugs (nirmatrelvir-ritonavir, remdesivir and molnupiravir) and 11 monoclonal antibodies have been marketed for the treatment of COVID-19, mostly requiring administration within 10 days of symptom onset. In addition, hospitalized patients with severe or critical COVID-19 may benefit from treatment with previously approved immunomodulatory drugs, including glucocorticoids such as dexamethasone, cytokine antagonists such as tocilizumab and Janus kinase inhibitors such as baricitinib.

• #3 Types of COVID-19 Treatment | COVID-19 | CDC

  https://www.cdc.gov/covid/treatment/index.html

  If you have COVID-19 and are more likely to get very sick, medications are available that can reduce your risk of hospitalization and death. […] Don’t delay: Treatments must be started within 5-7 days after you first develop symptoms to be effective. […] Treatment must be started within 5-7 days of when your symptoms first start. You do not need a positive test to start treatment so if you get sick and are at high risk for severe illness, talk to your healthcare provider as soon as possible. […] FDA has authorized or approved several antiviral medications used to treat mild to moderate COVID-19 in people who are more likely to get very sick. […] Antiviral medications target specific parts of the virus to stop it from multiplying in the body once someone is infected, helping to prevent severe illness and death.

• #4 COVID-19 Treatment Clinical Care for Outpatients | COVID-19 | CDC

  https://www.cdc.gov/covid/hcp/clinical-care/outpatient-treatment.html

  Clinicians should consider COVID-19 treatment in patients with mild or moderate COVID-19 who have one or more risk factors for severe COVID-19 to reduce progression to hospitalization and death. […] Treatment must be started as soon as possible and within 5-7 days of symptom onset. […] Patients who are at higher risk for severe COVID-19 might benefit from outpatient treatment. […] To minimize delays in antiviral treatment for patients at higher risk for severe COVID-19, use a nucleic acid amplification test (NAAT), such as a PCR test, when possible, for reliable diagnosis. […] In a clinical trial, ritonavir-boosted nirmatrelvir reduced the risk of hospitalization and death by 87% in unvaccinated outpatients with COVID-19 at higher risk of severe disease. […] Remdesivir (Veklury) reduced the risk of hospitalization and death by 87% in unvaccinated outpatients with COVID-19 who are at higher risk of severe disease.

• #5 IDSA Guidelines on the Treatment and Management of Patients with COVID-19

  https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/

  Vilobelimab: A new recommendation was developed on the use of vilobelimab in patients with critical COVID-19 requiring mechanical ventilation or ECMO. This focused update has been endorsed by The Society of Infectious Diseases Pharmacists (SIDP), The Society for Healthcare Epidemiology of America (SHEA) and The Society of Critical Care Medicine (SCCM). […] Pemivibart: A new recommendation was developed on the use of pemivibart in moderately to severely immunocompromised adolescents and adults at risk for progression to severe COVID-19. […] During the early phase of the infection, when viral load is high and the hosts adaptive immune system has not mounted an adequate response, treatments targeting viral replication are most likely to be effective. These include both the direct antiviral therapies nirmatrelvir/ritonavir, molnupiravir, and remdesivir; and the passive immunity therapies of anti-SARS-CoV-2 antibodies and donor convalescent plasma. Timely initiation of antiviral therapies is critical as they are more efficacious when given within 5 to 7 days of symptom onset.

• #6 IDSA Guidelines on the Treatment and Management of Patients with COVID-19

  https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/

  Vilobelimab: A new recommendation was developed on the use of vilobelimab in patients with critical COVID-19 requiring mechanical ventilation or ECMO. This focused update has been endorsed by The Society of Infectious Diseases Pharmacists (SIDP), The Society for Healthcare Epidemiology of America (SHEA) and The Society of Critical Care Medicine (SCCM). […] Pemivibart: A new recommendation was developed on the use of pemivibart in moderately to severely immunocompromised adolescents and adults at risk for progression to severe COVID-19. […] During the early phase of the infection, when viral load is high and the hosts adaptive immune system has not mounted an adequate response, treatments targeting viral replication are most likely to be effective. These include both the direct antiviral therapies nirmatrelvir/ritonavir, molnupiravir, and remdesivir; and the passive immunity therapies of anti-SARS-CoV-2 antibodies and donor convalescent plasma. Timely initiation of antiviral therapies is critical as they are more efficacious when given within 5 to 7 days of symptom onset.

• #7 COVID-19 drugs: Are there any that work?

  https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/coronavirus-drugs/faq-20485627

  COVID-19 medicine can help people who are at risk of, diagnosed with, or have symptoms of coronavirus disease 2019 (COVID-19). The medicine helps manage symptoms, stop the virus that causes COVID-19 from spreading in the body, and manage the body’s immune system response. […] Your healthcare professional may suggest certain medicines if you test positive for COVID-19 and are at high risk of serious illness. These medicines keep mild illness from getting worse. They can include nirmatrelvir-ritonavir (Paxlovid), remdesivir (Veklury) or molnupiravir (Lagevrio). […] Paxlovid combines two medicines. The first, called nirmatrelvir, blocks the activity of an enzyme the COVID-19 virus needs to copy itself, also called replicate. The second medicine, called ritonavir, helps slow the breakdown of nirmatrelvir. Paxlovid is approved to treat mild to moderate COVID-19 in people age 12 and older who are at higher risk of serious illness. The medicine is taken by mouth as a pill.

• #8 COVID-19 drugs: Are there any that work?

  https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/coronavirus-drugs/faq-20485627

  Remdesivir is a medicine that blocks the virus that causes COVID-19 from spreading in the body. It’s used to treat COVID-19 in people age 12 and older. It’s given through a needle into a vein, known as intravenously (IV). […] The FDA has authorized an antiviral drug called molnupiravir. Molnupiravir treats mild to moderate COVID-19 in adults at higher risk of serious illness who can’t take other treatments. The medication is taken by mouth as a pill. […] People in the hospital with serious COVID-19 may get remdesivir. Another option is a corticosteroid, such as dexamethasone. That medicine helps lower inflammation. […] Baricitinib, a pill, seems to treat COVID-19 as an antiviral medicine and by lowering inflammation. Tocilizumab is a shot, also called an injection, that seems to work against the COVID-19 virus by lowering inflammation. Healthcare professionals may use these medicines for people in the hospital with COVID-19 who need supplemental oxygen or machines to help them breathe.

• #9 Therapeutic Options for COVID-19 Patients – MN Dept. of Health

  https://www.health.state.mn.us/diseases/coronavirus/hcp/therapeutic.html

  Nirmatrelvir/ritonavir (Paxlovid) and molnupiravir (Lagevrio) are authorized for the treatment of mild to moderate COVID-19 in patients at increased risk for severe illness. Paxlovid is the preferred first line therapy and is FDA-approved for use in adults and children aged older than 12 years. Molnupiravir is authorized for use in adults 18 years and older for whom other therapies are not available or clinically appropriate. Patients are not required to have a positive test to be treated with oral antivirals but should have a current clinical diagnosis of mild to moderate COVID-19. […] Currently the preferred first-line therapy for treatment of eligible patients with COVID-19. […] Authorized for the treatment of mild-to-moderate COVID-19 in patients at high risk for severe illness from COVID-19.

• #10 Therapeutic Options for COVID-19 Patients – MN Dept. of Health

  https://www.health.state.mn.us/diseases/coronavirus/hcp/therapeutic.html

  Treatment must be started within five days of symptom onset and is given as a five-day treatment course. […] Efficacy: In the EPIC-HR trial (Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults, New England Journal of Medicine), ritonavir-boosted nirmatrelvir (Paxlovid) reduced the risk of hospitalization or death by 89% compared to placebo in non-hospitalized, high-risk, unvaccinated adults with laboratory-confirmed SARS-CoV-2 infection. […] Currently recommended as an alternative therapy for use when the preferred therapies (Paxlovid or outpatient remdesivir) are not available, feasible to use, or clinically appropriate. […] Authorized for the treatment of mild to moderate COVID-19 in patients at high risk for severe illness from COVID-19. […] Treatment must be started within five days of symptom onset and is given as a five-day treatment course.

• #11 Coronavirus Disease 2019 (COVID-19) Treatment & Management: Approach Considerations, Medical Care, Complications

  https://emedicine.medscape.com/article/2500114-treatment

  Remdesivir, an antiviral medication, has been shown to be effective in reducing the risk of hospitalization or death in high-risk individuals with mild-to-moderate COVID-19. […] Nirmatrelvir/ritonavir (Paxlovid) has been shown to be effective in reducing the risk of hospitalization or death in high-risk individuals with mild-to-moderate COVID-19. […] The EPIC-HR trial, which included 2,246 high-risk adults, demonstrated a significant reduction in the risk of hospitalization or death by 89.1% when nirmatrelvir/ritonavir treatment was initiated within 3 days of symptom onset and by 88% when initiated within 5 days compared to a placebo. […] An Emergency Use Authorization (EUA) was granted for molnupiravir on December 23, 2021, for the treatment of mild-to-moderate COVID-19 in adults aged 18 years and older who are at high risk for progression to severe disease.

• #12 13 Things To Know About Paxlovid, the Latest COVID-19 Pill > News > Yale Medicine

  https://www.yalemedicine.org/news/13-things-to-know-paxlovid-covid-19

  Paxlovid is an antiviral therapy that consists of two separate medications packaged together. […] You have to take Paxlovid within five days of developing symptoms. […] Like all antivirals, Paxlovid works best early in the course of an illnessin this case, within the first five days of symptom onset, says Jeffrey Topal, MD, a Yale Medicine infectious diseases specialist who is involved in determining COVID treatment protocols for Yale New Haven Hospital patients. […] The standard dose is three Paxlovid pills twice daily (in the morning and at bedtime) for five days for a full course that adds up to 30 pills. […] In order to qualify for a prescription, you must be at high risk for developing severe COVID. […] The FDA’s approval of Paxlovid for adults in 2023 was based on the totality of scientific evidence submitted by Pfizer, including efficacy data from a Phase 2/3 study showing an 86% reduction in risk of COVID-related hospitalization or death from any cause in patients who took Paxlovid within five days of symptom onset.

• #13 13 Things To Know About Paxlovid, the Latest COVID-19 Pill > News > Yale Medicine

  https://www.yalemedicine.org/news/13-things-to-know-paxlovid-covid-19

  Paxlovid, an oral antiviral pill that can be taken at home, is the go-to treatment for COVID-19. If you are at high risk for severe disease from COVID, and you take it within the first five days of experiencing symptoms, it will lower your risk of getting so sick that you need to be hospitalized. […] The Food and Drug Administration (FDA) gave the drug full approval in May 2023 for adults with mild-to-moderate COVID at high risk for severe disease, hospitalization, and death. […] It’s really our first efficacious oral antiviral pill for this virus, says Scott Roberts, MD, a Yale Medicine infectious diseases specialist. It shows clear benefit, and it really can prevent hospitalization and death in people who are at high risk. […] The drug, developed by Pfizer, had an 89% reduction in the risk of hospitalization and death in unvaccinated people in the clinical trial that supported the EUA, a number that was high enough to prompt the National Institutes of Health (NIH) to prioritize it over other COVID treatments.

• #14 :: JKMS :: Journal of Korean Medical Science

  https://jkms.org/DOIx.php?id=10.3346/jkms.2022.37.e352

  The coronavirus disease 2019 (COVID-19) continues to threaten public health in Korea although several surges have passed in the past 3 years since 2019. […] Although patients with mild-to-moderate COVID-19 can usually recover at home, antiviral therapy to prevent disease progression and hospitalization is beneficial for those at high risk of progressing to severe COVID-19. […] Several evidence-based treatment guidelines have been developed in Korea, including those derived from domestic studies. […] Currently, three types of antiviral agents nirmatrelvir-ritonavir, molnupiravir, and remdesivir are available in Korea to treat severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. […] For most individuals, nirmatrelvir/ritonavir is preferred because of its high efficacy and convenience of administration.

• #15 Coronavirus Disease 2019 Treatment: A Review of Early and Emerging Options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7144823/

  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), has spread across the globe resulting in a pandemic. […] On behalf of the Society of Infectious Diseases Pharmacists, we herein summarize the current evidence as of March 18, 2020 to provide guidance on potential COVID-19 treatment options. It is important to caution readers that new data emerges daily regarding clinical characteristics, treatment options, and outcomes for COVID-19. Optimized supportive care remains the mainstay of therapy, and the clinical efficacy for the subsequent agents is still under investigation. […] Remdesivir (GS-5734) is an investigational monophosphoramidate prodrug of an adenosine analog that was developed by Gilead Sciences, Inc. in response to the Ebola outbreak in West Africa from 2014 to 2016.

• #16

  https://link.springer.com/article/10.1007/s11908-021-00769-8

  Given the rapidly evolving medical literature and treatment paradigms, it is recommended to reference continuously updated, curated guidelines from national and international sources. While the drugs and management strategies mentioned in this review represent the current state of recommendations, many therapies are still under investigation to further define optimal COVID-19 treatment. […] Remdesivir is a prodrug that is metabolized to a nucleoside triphosphate analogue to inhibit viral ribonucleic acid (RNA) polymerase by inducing delayed chain termination. […] In May 2020, the US Food and Drug Administration (FDA) approved remdesivir via emergency use authorization (EUA) for clinical use based on the SIMPLE-Severe trial and a preliminary report of the ACTT-1 trial. […] Remdesivir is currently FDA approved for the treatment of COVID-19 in hospitalized patients.

• #17 Coronavirus Disease 2019 (COVID-19) Treatment & Management: Approach Considerations, Medical Care, Complications

  https://emedicine.medscape.com/article/2500114-treatment

  Utilization of programs established by the FDA to allow clinicians to gain access to investigational therapies during the pandemic has been essential. The expanded access (EA) and emergency use authorization (EUA) programs allowed for rapid deployment of potential therapies for investigation and investigational therapies with emerging evidence. […] Remdesivir, an antiviral agent, was the first drug to gain full FDA approval for treatment of hospitalized adults and adolescents with COVID-19 disease in October 2020. Since then, it has gained approval for adults and pediatric patients (birth who weigh at least 1.5 kg) with mild-to-moderate COVID-19 disease who are hospitalized, or not hospitalized and are at high risk for progression to severe COVID-19, including hospitalization or death. […] Treatment does not preclude isolation and masking for those who test positive for SARS-CoV-2.

• #18 Coronavirus Disease 2019 Treatment: A Review of Early and Emerging Options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7144823/

  The dose under investigation for treatment of COVID-19 is 200 mg intravenously (IV) on day 1 followed by 100 mg IV daily for up to 10 days, infused over 3060 minutes. […] Emerging clinical evidence and available in vitro data suggest remdesivir is a promising agent for the treatment of COVID-19. […] Chloroquine, an antimalarial agent with anti-inflammatory and immunomodulatory activities, has gained significant interest as a potential therapeutic option for the management of COVID-19. […] Although this development has been encouraging, supply issues in the United States and cardiovascular toxicity concerns limit the use of chloroquine. […] Hydroxychloroquine is perceived as having better tolerability than chloroquine, which has led to long-term usage in rheumatological disorders. […] The authors concluded that these data support the lower dose regimen because RLTEC values were significantly higher than those with the proven efficacious regimen of 500 mg of chloroquine by mouth twice daily.

• #19 Treatments for COVID-19 | Mass.gov

  https://www.mass.gov/info-details/treatments-for-covid-19

  Molnupiravir (must be taken within 5 days of your first COVID-19 symptom) is an antiviral treatment pill that reduces the COVID-19 virus’ ability to multiply in the body. […] Remdesivir (must be given within 7 days of your first COVID-19 symptom) is an antiviral infusion medication administered over the course of 3 days for individuals who have mild-to-moderate COVID-19 and are at high risk for severe COVID-19. […] Call your doctor right away to learn about your treatment options if you are positive for COVID-19.

• #20 Types of COVID-19 Treatment | COVID-19 | CDC

  https://www.cdc.gov/covid/treatment/index.html

  Several treatment options are available for treating COVID-19. […] Nirmatrelvir with Ritonavir (Paxlovid) must begin within 5 days of when symptoms start. […] Veklury (remdesivir) must begin within 7 days of when symptoms start. […] Molnupiravir (Lagevrio) must begin within 5 days of when symptoms start. […] Some treatments might have side effects or interact with other medications you are taking. […] If you are hospitalized, your healthcare provider might use other types of medications, depending on how sick you are. […] If you have a weakened immune system, have received antiviral treatment, and continue to experience COVID-19 symptoms, your healthcare provider may recommend additional treatment, including convalescent plasma. […] COVID-19 oral antiviral treatments Paxlovid and Lagevrio are available for certain people at a lower cost. […] Talk to a healthcare provider about taking medications to treat COVID-19. […] The benefits of COVID-19 treatment outweigh the risk of rebound if you are at high risk for severe COVID-19.

• #21 Therapeutic Options for COVID-19 Patients – MN Dept. of Health

  https://www.health.state.mn.us/diseases/coronavirus/hcp/therapeutic.html

  In the PINETREE trial (Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients, New England Journal of Medicine), three consecutive days of IV remdesivir resulted in an 87% reduction in the risk of hospitalization or death compared to placebo in non-hospitalized, high-risk, unvaccinated patients with laboratory-confirmed SARS-CoV-2 infection. […] Tocilizumab is an interleukin (IL)-6 inhibitor that can be used in hospitalized patients with progressive severe or critical COVID-19 illness that demonstrate elevated markers of inflammation. […] Baricitinib is a Janus kinase (JAK) inhibitor that can be used in hospitalized patients with severe COVID-19 disease and elevated inflammatory markers, but not requiring mechanical ventilation.

• #22 COVID-19 Treatment Clinical Care for Outpatients | COVID-19 | CDC

  https://www.cdc.gov/covid/hcp/clinical-care/outpatient-treatment.html

  Clinicians should consider COVID-19 treatment in patients with mild or moderate COVID-19 who have one or more risk factors for severe COVID-19 to reduce progression to hospitalization and death. […] Treatment must be started as soon as possible and within 5-7 days of symptom onset. […] Patients who are at higher risk for severe COVID-19 might benefit from outpatient treatment. […] To minimize delays in antiviral treatment for patients at higher risk for severe COVID-19, use a nucleic acid amplification test (NAAT), such as a PCR test, when possible, for reliable diagnosis. […] In a clinical trial, ritonavir-boosted nirmatrelvir reduced the risk of hospitalization and death by 87% in unvaccinated outpatients with COVID-19 at higher risk of severe disease. […] Remdesivir (Veklury) reduced the risk of hospitalization and death by 87% in unvaccinated outpatients with COVID-19 who are at higher risk of severe disease.

• #23 Therapeutic Options for COVID-19 Patients – MN Dept. of Health

  https://www.health.state.mn.us/diseases/coronavirus/hcp/therapeutic.html

  In the MOVe-OUT trial (Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients, New England Journal of Medicine) molnupiravir reduced the rate of hospitalization or death by 30% compared to placebo in non-hospitalized, unvaccinated, high-risk adults with laboratory-confirmed SARS-CoV-2 infection. […] Remdesivir is approved by the FDA under the name Veklury for the treatment of COVID-19 in adult and pediatric patients (ages 28 days and older and weighing at least 3 kg) who are either hospitalized or who are not hospitalized but have mild to moderate COVID-19 and are at high risk for progression to severe illness. […] Currently recommended as a preferred therapy for use in eligible patients if Paxlovid is not clinically appropriate (e.g., due to significant drug-drug interactions).

• #24 :: JKMS :: Journal of Korean Medical Science

  https://jkms.org/DOIx.php?id=10.3346/jkms.2022.37.e352

  When serious drug interactions occur or are expected with nirmatrelvir/ritonavir administration, 3 days of remdesivir treatment is shown to be a reasonable alternative. […] Molnupiravir may be prescribed with caution only if no other therapeutic options are available or acceptable. […] Antiviral therapies are mainly used to prevent disease progression, hospitalization, and death for patients with mild-to-moderate COVID-19. […] Unfortunately, despite many clinical trials investigating new or repurposed antiviral agents, there is no curative therapy for COVID-19. […] Remdesivir has been shown to improve clinical outcomes in patients hospitalized with moderate-to-severe disease. […] In Korea, remdesivir was rolled out under emergency use authorization by the Korean Ministry of Food and Drug Safety (MFDS) on July 1, 2020.

• #25 COVID-19 drugs: Are there any that work?

  https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/coronavirus-drugs/faq-20485627

  Remdesivir is a medicine that blocks the virus that causes COVID-19 from spreading in the body. It’s used to treat COVID-19 in people age 12 and older. It’s given through a needle into a vein, known as intravenously (IV). […] The FDA has authorized an antiviral drug called molnupiravir. Molnupiravir treats mild to moderate COVID-19 in adults at higher risk of serious illness who can’t take other treatments. The medication is taken by mouth as a pill. […] People in the hospital with serious COVID-19 may get remdesivir. Another option is a corticosteroid, such as dexamethasone. That medicine helps lower inflammation. […] Baricitinib, a pill, seems to treat COVID-19 as an antiviral medicine and by lowering inflammation. Tocilizumab is a shot, also called an injection, that seems to work against the COVID-19 virus by lowering inflammation. Healthcare professionals may use these medicines for people in the hospital with COVID-19 who need supplemental oxygen or machines to help them breathe.

• #26 Therapeutic Options for COVID-19 Patients – MN Dept. of Health

  https://www.health.state.mn.us/diseases/coronavirus/hcp/therapeutic.html

  Treatment must be started within five days of symptom onset and is given as a five-day treatment course. […] Efficacy: In the EPIC-HR trial (Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults, New England Journal of Medicine), ritonavir-boosted nirmatrelvir (Paxlovid) reduced the risk of hospitalization or death by 89% compared to placebo in non-hospitalized, high-risk, unvaccinated adults with laboratory-confirmed SARS-CoV-2 infection. […] Currently recommended as an alternative therapy for use when the preferred therapies (Paxlovid or outpatient remdesivir) are not available, feasible to use, or clinically appropriate. […] Authorized for the treatment of mild to moderate COVID-19 in patients at high risk for severe illness from COVID-19. […] Treatment must be started within five days of symptom onset and is given as a five-day treatment course.

• #27 Types of COVID-19 Treatment | COVID-19 | CDC

  https://www.cdc.gov/covid/treatment/index.html

  Several treatment options are available for treating COVID-19. […] Nirmatrelvir with Ritonavir (Paxlovid) must begin within 5 days of when symptoms start. […] Veklury (remdesivir) must begin within 7 days of when symptoms start. […] Molnupiravir (Lagevrio) must begin within 5 days of when symptoms start. […] Some treatments might have side effects or interact with other medications you are taking. […] If you are hospitalized, your healthcare provider might use other types of medications, depending on how sick you are. […] If you have a weakened immune system, have received antiviral treatment, and continue to experience COVID-19 symptoms, your healthcare provider may recommend additional treatment, including convalescent plasma. […] COVID-19 oral antiviral treatments Paxlovid and Lagevrio are available for certain people at a lower cost. […] Talk to a healthcare provider about taking medications to treat COVID-19. […] The benefits of COVID-19 treatment outweigh the risk of rebound if you are at high risk for severe COVID-19.

• #28 Therapeutic Options for COVID-19 Patients – MN Dept. of Health

  https://www.health.state.mn.us/diseases/coronavirus/hcp/therapeutic.html

  In the MOVe-OUT trial (Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients, New England Journal of Medicine) molnupiravir reduced the rate of hospitalization or death by 30% compared to placebo in non-hospitalized, unvaccinated, high-risk adults with laboratory-confirmed SARS-CoV-2 infection. […] Remdesivir is approved by the FDA under the name Veklury for the treatment of COVID-19 in adult and pediatric patients (ages 28 days and older and weighing at least 3 kg) who are either hospitalized or who are not hospitalized but have mild to moderate COVID-19 and are at high risk for progression to severe illness. […] Currently recommended as a preferred therapy for use in eligible patients if Paxlovid is not clinically appropriate (e.g., due to significant drug-drug interactions).

• #29 Coronavirus Disease 2019 (COVID-19) Treatment & Management: Approach Considerations, Medical Care, Complications

  https://emedicine.medscape.com/article/2500114-treatment

  Results from the phase 3 MOVe-OUT study showed that molnupiravir reduced the risk of hospitalization or death compared to a placebo, with a relative risk reduction of 30%. […] Early in the pandemic, drugs (eg, interleukin inhibitors, Janus kinase inhibitor) were identified that may modulate the immunologic pathways associated with the hyperinflammation observed with COVID-19. […] Baricitinib is the first immunotherapy to gain full FDA approval in May 2022 for treatment of hospitalized adults who require supplemental oxygen, noninvasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). […] The UK RECOVERY trial was a landmark study that demonstrated the benefits of using low-dose dexamethasone in hospitalized patients with COVID-19. […] Overall, the evidence from these studies underscores the importance of corticosteroid therapy in improving outcomes for hospitalized patients with severe cases of COVID-19, particularly those requiring respiratory support.

• #30 :: JKMS :: Journal of Korean Medical Science

  https://jkms.org/DOIx.php?id=10.3346/jkms.2022.37.e352

  Molnupiravir was conditionally approved on March 23, 2022, in Korea for the treatment of adults (age 18 years) with mild-to-moderate COVID-19 within 5 days of symptom onset and at high risk of severe illness. […] Its use was only approved in circumstances in which both nirmatrelvir/ritonavir and remdesivir cannot be used. […] As of November 2022, the available approved antiviral agents for the treatment of mild-to-moderate SARS-CoV-2 infection in Korea include nirmatrelvir/ritonavir, molnupiravir, and remdesivir. […] No monoclonal antibody is currently recommended for use in patients with COVID-19.

• #31 Information for providers about therapeutic treatments for COVID-19 | Mass.gov

  https://www.mass.gov/info-details/information-for-providers-about-therapeutic-treatments-for-covid-19

  Similar effectiveness can be achieved with the intravenous antiviral remdesivir (VEKLURY) which requires infusion on 3 consecutive days and must be started within 7 days of symptom onset. […] If neither of these therapeutics is available or appropriate, the oral medication molnupiravir may be given starting within 5 days of symptom onset. […] Use of antiviral IV therapy or oral antiviral medications is not a substitute for vaccination against COVID-19. Everyone is still encouraged to stay up to date with COVID-19 vaccinations. […] COVID-19 treatments should be considered for all your patients and given to all patients appropriate for treatment. […] This group includes a large percentage of all MA residents eligible due to heart, lung, liver, or kidney disease, diabetes, pregnancy, dementia, cancer, disability, substance use disorder, mental health disorder, age over 65, overweight/obesity and immunocompromised. […] Additionally, hospitals and other healthcare providers throughout Massachusetts serve as sites for distribution of COVID-19 therapeutics and will administer remdesivir and dispense oral antiviral therapy.

• #32 Therapeutic strategies for COVID-19: progress and lessons learned | Nature Reviews Drug Discovery

  https://www.nature.com/articles/s41573-023-00672-y

  The coronavirus disease 2019 (COVID-19) pandemic has stimulated tremendous efforts to develop therapeutic strategies that target severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and/or human proteins to control viral infection, encompassing hundreds of potential drugs and thousands of patients in clinical trials. So far, a few small-molecule antiviral drugs (nirmatrelvir-ritonavir, remdesivir and molnupiravir) and 11 monoclonal antibodies have been marketed for the treatment of COVID-19, mostly requiring administration within 10 days of symptom onset. In addition, hospitalized patients with severe or critical COVID-19 may benefit from treatment with previously approved immunomodulatory drugs, including glucocorticoids such as dexamethasone, cytokine antagonists such as tocilizumab and Janus kinase inhibitors such as baricitinib.

• #33 COVID-19: Management in hospitalized adults – UpToDate

  https://www.uptodate.com/contents/covid-19-management-in-hospitalized-adults

  COVID-19: Management in hospitalized adults […] This topic will discuss the management of COVID-19 in hospitalized adults. […] Guidance has been issued by the World Health Organization and, in the United States, by the National Institutes of Health COVID-19 Treatment Guidelines Panel. […] COVID-19-SPECIFIC THERAPY […] Specific treatments […] Dexamethasone and other glucocorticoids […] Adjunctive immunomodulators […] Baricitinib and JAK inhibitors […] IL-6 pathway inhibitors (eg, tocilizumab) […] Limited roles for alternative immunomodulators […] Remdesivir […] Limited role for antibody-based therapies (monoclonal antibodies and convalescent plasma).

• #34 Therapeutic strategies for COVID-19: progress and lessons learned | Nature Reviews Drug Discovery

  https://www.nature.com/articles/s41573-023-00672-y

  Owing to space limitations, readers are encouraged to consult other reviews about SARS-CoV-2 vaccines, diagnostics, biology and pathogenesis, acute and post-acute syndrome, immunology and inflammation, protein structures and functions, emerging variants and antiviral drugs against other coronaviruses. […] Systemic corticosteroids are widely available and affordable anti-inflammatory and immunosuppressive drugs for the treatment of autoimmune and inflammatory diseases. Corticosteroids can be classified into glucocorticoids (such as dexamethasone, hydrocortisone, prednisolone and methylprednisolone) and mineralocorticoids (such as fludrocortisone). The former exert anti-inflammatory action and immune regulation with clinical benefits for inpatients with severe COVID-19. Dexamethasone is the first glucocorticoid identified with clinical benefit among inpatients with severe COVID-19. Soon after the COVID-19 outbreak, the RECOVERY study showed that dexamethasone significantly reduced 28-day mortality among inpatients with COVID-19 who required respiratory support.

• #35 Therapeutic strategies for COVID-19: progress and lessons learned | Nature Reviews Drug Discovery

  https://www.nature.com/articles/s41573-023-00672-y

  Owing to space limitations, readers are encouraged to consult other reviews about SARS-CoV-2 vaccines, diagnostics, biology and pathogenesis, acute and post-acute syndrome, immunology and inflammation, protein structures and functions, emerging variants and antiviral drugs against other coronaviruses. […] Systemic corticosteroids are widely available and affordable anti-inflammatory and immunosuppressive drugs for the treatment of autoimmune and inflammatory diseases. Corticosteroids can be classified into glucocorticoids (such as dexamethasone, hydrocortisone, prednisolone and methylprednisolone) and mineralocorticoids (such as fludrocortisone). The former exert anti-inflammatory action and immune regulation with clinical benefits for inpatients with severe COVID-19. Dexamethasone is the first glucocorticoid identified with clinical benefit among inpatients with severe COVID-19. Soon after the COVID-19 outbreak, the RECOVERY study showed that dexamethasone significantly reduced 28-day mortality among inpatients with COVID-19 who required respiratory support.

• #36 IDSA Guidelines on the Treatment and Management of Patients with COVID-19

  https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/

  Patients who have these risk factors should be offered treatment with nirmatrelvir/ritonavir for 5 days (oral) or remdesivir for 3 days (intravenous). If these agents are not available or cannot be used then consider molnupiravir for 5 days (oral) or, if immunocompromised, high-titer convalescent plasma (intravenous) with activity against circulating variant. […] We recommend against the use of ivermectin outside of the context of a clinical trial given the low certainty of evidence for its benefit. […] Among hospitalized critically ill patients with COVID-19, the IDSA guideline panel recommends dexamethasone rather than no dexamethasone. […] The IL-6 inhibitors tocilizumab and sarilumab have shown a benefit in severe, but non-critical COVID-19 when used with corticosteroids. […] The guideline panel suggests baricitinib in addition to standard of care for patients hospitalized with severe COVID-19.

• #37 Coronavirus disease 2019 (COVID-19) – Treatment algorithm | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/3000168/treatment-algorithm

  Evidence for the use of antivirals in patients with nonsevere disease is limited. […] Remdesivir was found to reduce the risk of hospitalization or death by 87% compared with placebo in nonhospitalized high-risk adults in a randomized, double-blind, placebo-controlled trial. […] The World Health Organization conditionally recommends the intravenous antiviral remdesivir in adults with severe disease. […] A Cochrane review found that tocilizumab reduced all-cause mortality at day 28 (high-certainty evidence) compared with standard care alone or placebo. […] The World Health Organization strongly recommends systemic corticosteroid therapy (low-dose intravenous or oral dexamethasone or hydrocortisone) for 7 to 10 days in adults with critical disease. […] Consider ECMO according to availability and expertise if the above methods fail.

• #38 Coronavirus Disease 2019 Treatment: A Review of Early and Emerging Options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7144823/

  The potential benefit of these agents to blunt the inflammatory cascade seen in severe disease needs to be carefully weighed against the concerns for secondary infections, adverse events, and other complications of corticosteroid therapy. […] The risks of ribavirin likely outweigh potential clinical benefit, and therefore ribavirin was not considered a viable candidate for further investigation by the WHO research and development plan for SARS-CoV-2 given its lack of in vitro efficacy, toxicity profile, and poor outcomes. […] Based on the poor in vitro activity, an absence of animal or human data supporting its use, and a significant toxicity profile, we recommend avoiding use of ribavirin in patients with COVID-19 at this time.

• #39 Coronavirus Disease 2019 Treatment: A Review of Early and Emerging Options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7144823/

  The therapeutic efficacy of remdesivir was first described in an animal model against Ebola among infected rhesus monkeys in which once-daily dosing resulted in suppression of viral replication and protection from lethal disease. […] The first report of a remdesivir-treated patient with COVID-19 in the United States was a 35-year-old male in Snohomish County, Washington who received treatment on hospital day 7 (illness day 11) due to developing pneumonia and persistent fevers. […] The therapeutic efficacy of remdesivir was first described in an animal model against Ebola among infected rhesus monkeys in which once-daily dosing resulted in suppression of viral replication and protection from lethal disease. […] Tocilizumab is a humanized monoclonal antibody that inhibits both membrane-bound and soluble interleukin-6 (IL-6) receptors.

• #40 Coronavirus Disease 2019 Treatment: A Review of Early and Emerging Options

  https://pmc.ncbi.nlm.nih.gov/articles/PMC7144823/

  Immunotherapy with tocilizumab is listed as a treatment option for severe or critical cases of COVID-19 with elevated IL-6 in the 7th edition of the National Health Commission of the Peoples Republic of China COVID-19 Diagnosis and Treatment Guide. […] The clinical data for use of corticosteroids in SARS-CoV-1 infections are mixed. […] Although target patients in whom corticosteroids will improve outcomes may exist (eg, those with cytokine-related lung injury who may develop rapidly progressive pneumonia), that population remains ill-defined. […] The data assessing the role of corticosteroids as adjunctive care for severe coronavirus (SARS-CoV-1, MERS-CoV, and SARS-CoV-2) pneumonia are difficult to interpret. […] Given the retrospective observational nature of these analyses, there is significant confounding by indication that is difficult to control or correct for in addition to limited sample sizes.

• #41 Therapeutic Options for COVID-19 Patients – MN Dept. of Health

  https://www.health.state.mn.us/diseases/coronavirus/hcp/therapeutic.html

  In the PINETREE trial (Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients, New England Journal of Medicine), three consecutive days of IV remdesivir resulted in an 87% reduction in the risk of hospitalization or death compared to placebo in non-hospitalized, high-risk, unvaccinated patients with laboratory-confirmed SARS-CoV-2 infection. […] Tocilizumab is an interleukin (IL)-6 inhibitor that can be used in hospitalized patients with progressive severe or critical COVID-19 illness that demonstrate elevated markers of inflammation. […] Baricitinib is a Janus kinase (JAK) inhibitor that can be used in hospitalized patients with severe COVID-19 disease and elevated inflammatory markers, but not requiring mechanical ventilation.

• #42 Coronavirus disease 2019 (COVID-19) – Treatment algorithm | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/3000168/treatment-algorithm

  Evidence for the use of antivirals in patients with nonsevere disease is limited. […] Remdesivir was found to reduce the risk of hospitalization or death by 87% compared with placebo in nonhospitalized high-risk adults in a randomized, double-blind, placebo-controlled trial. […] The World Health Organization conditionally recommends the intravenous antiviral remdesivir in adults with severe disease. […] A Cochrane review found that tocilizumab reduced all-cause mortality at day 28 (high-certainty evidence) compared with standard care alone or placebo. […] The World Health Organization strongly recommends systemic corticosteroid therapy (low-dose intravenous or oral dexamethasone or hydrocortisone) for 7 to 10 days in adults with critical disease. […] Consider ECMO according to availability and expertise if the above methods fail.

• #43

  https://link.springer.com/article/10.1007/s11908-021-00769-8

  Monoclonal antibodies (mAbs) provide passive immunity against SARS-CoV-2 via direct administration of SARS-CoV-2 antibodies, resulting in a more rapid viral neutralization than occurs naturally upon viral exposure. […] The proposed primary benefit of convalescent plasma occurs via pathogen neutralization through antibodies; however, other mechanisms may exist as well. […] The largest RCT to-date was the UK-based RECOVERY trial. […] Based on the RECOVERY trial results, several other clinical trials were terminated early for ethical concerns regarding withholding corticosteroid treatment. […] Based on evidence from the REMAP-CAP and RECOVERY studies, tocilizumab is recommended in combination with corticosteroids in those recently hospitalized with rapidly increasing oxygen requirements and CRP75 mg/dL or within 24 h of ICU admission.

• #44 COVID-19 & EUA Treatment Info | ACTEMRA® (tocilizumab)

  https://www.actemrahcp.com/covid-19.html

  The US Food and Drug Administration (FDA) has issued an EUA for the emergency use of ACTEMRA for the treatment of coronavirus disease 2019 (COVID-19) in hospitalized pediatric patients (2 years of age and older) who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). However, ACTEMRA is not FDA-approved for use in pediatric patients with COVID-19. […] ACTEMRA is authorized for use under an Emergency Use Authorization (EUA) for the treatment of coronavirus disease 2019 (COVID-19) in hospitalized pediatric patients (2 years of age and older) who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).

• #45 Therapeutic Options for COVID-19 Patients – MN Dept. of Health

  https://www.health.state.mn.us/diseases/coronavirus/hcp/therapeutic.html

  In the PINETREE trial (Early Remdesivir to Prevent Progression to Severe Covid-19 in Outpatients, New England Journal of Medicine), three consecutive days of IV remdesivir resulted in an 87% reduction in the risk of hospitalization or death compared to placebo in non-hospitalized, high-risk, unvaccinated patients with laboratory-confirmed SARS-CoV-2 infection. […] Tocilizumab is an interleukin (IL)-6 inhibitor that can be used in hospitalized patients with progressive severe or critical COVID-19 illness that demonstrate elevated markers of inflammation. […] Baricitinib is a Janus kinase (JAK) inhibitor that can be used in hospitalized patients with severe COVID-19 disease and elevated inflammatory markers, but not requiring mechanical ventilation.

• #46 Coronavirus Disease 2019 (COVID-19) Treatment & Management: Approach Considerations, Medical Care, Complications

  https://emedicine.medscape.com/article/2500114-treatment

  Baricitinib (Olumiant), a Janus kinase inhibitor, gained FDA approval for hospitalized adults with COVID-19 disease who require supplemental oxygen, noninvasive or invasive mechanical ventilation, or ECMO. An EUA for children has been issued for baricitinib. […] Similar to baricitinib, tocilizumab (Actemra), an interleukin 6 inhibitor, was approved by the FDA for hospitalized adults. An EUA remains in place for children aged 2 years and older. […] Use of corticosteroids improves survival in hospitalized patients with severe COVID-19 disease requiring supplemental oxygen, with the greatest benefit shown in those requiring mechanical ventilation. […] All infected patients should receive supportive care to help alleviate symptoms. Vital organ function should be supported in severe cases.

• #47 Therapeutic strategies for COVID-19: progress and lessons learned | Nature Reviews Drug Discovery

  https://www.nature.com/articles/s41573-023-00672-y

  The oral regimen of baricitinib (tofacitinib is an alternative option if baricitinib is unavailable) plus systemic glucocorticoids such as dexamethasone is recommended by the NIH and Infectious Diseases Society of America (IDSA) guidelines to inpatients with severe or critical COVID-19 under certain conditions. […] The efficacy and safety of baricitinib in inpatients with COVID-19 have been shown in randomized phase III trials such as RECOVERY, COV-BARRIER and ACTT-2. Both RECOVERY and COV-BARRIER reported a benefit of baricitinib in reducing 28-day all-cause mortality. […] The phase III SCORPIO-HR trial is investigating the efficacy and safety of oral ensitrelvir in high-risk outpatients with COVID-19. […] Remdesivir was granted an EUA for the treatment of COVID-19 under certain conditions by the FDA in May 2020, which was followed by approval or authorization in many countries. Clinical benefits of remdesivir versus placebo or standard care have been indicated by randomized trials such as ACTT-1 and PINETREE, whereas an added value of remdesivir was absent in Solidarity and DisCoVeRy.

• #48 JAK-inhibitors for coronavirus disease-2019 (COVID-19): a meta-analysis | Leukemia

  https://www.nature.com/articles/s41375-021-01266-6

  We analyzed reports on safety and efficacy of JAK-inhibitors in patients with coronavirus infectious disease-2019 (COVID-19) published between January 1st and March 6th 2021 using the Newcastle-Ottawa and Jadad scales for quality assessment. […] Use of JAK-inhibitors decreased use of invasive mechanical ventilation (RR = 0.63; [95% Confidence Interval (CI), 0.47, 0.84]; P=0.002) and had borderline impact on rates of intensive care unit (ICU) admission (RR = 0.24 [0.06, 1.02]; P=0.05) and acute respiratory distress syndrome (ARDS; RR = 0.50 [0.19, 1.33]; P=0.16). […] JAK-inhibitors did not decrease length of hospitalization (mean difference (MD) 0.18 [4.54, 4.18]; P=0.94). […] Relative risks of death for both drugs were 0.42 [0.30, 0.59] (P0.001), for ruxolitinib, RR = 0.33 (0.13, 0.88; P=0.03) and for baricitinib RR = 0.44 (0.31, 0.63; P0.001).

• #49 JAK-inhibitors for coronavirus disease-2019 (COVID-19): a meta-analysis | Leukemia

  https://www.nature.com/articles/s41375-021-01266-6

  The use of JAK-inhibitors in persons with COVID-19 decreased the use of invasive mechanical ventilation and increased survival, most convincingly for baricitinib. […] Our study has limitations. […] In conclusion, we found a potential role for JAK-inhibitors in reducing the risk of death in persons with COVID-19.

• #50 Therapeutic strategies for COVID-19: progress and lessons learned | Nature Reviews Drug Discovery

  https://www.nature.com/articles/s41573-023-00672-y

  The oral regimen of baricitinib (tofacitinib is an alternative option if baricitinib is unavailable) plus systemic glucocorticoids such as dexamethasone is recommended by the NIH and Infectious Diseases Society of America (IDSA) guidelines to inpatients with severe or critical COVID-19 under certain conditions. […] The efficacy and safety of baricitinib in inpatients with COVID-19 have been shown in randomized phase III trials such as RECOVERY, COV-BARRIER and ACTT-2. Both RECOVERY and COV-BARRIER reported a benefit of baricitinib in reducing 28-day all-cause mortality. […] The phase III SCORPIO-HR trial is investigating the efficacy and safety of oral ensitrelvir in high-risk outpatients with COVID-19. […] Remdesivir was granted an EUA for the treatment of COVID-19 under certain conditions by the FDA in May 2020, which was followed by approval or authorization in many countries. Clinical benefits of remdesivir versus placebo or standard care have been indicated by randomized trials such as ACTT-1 and PINETREE, whereas an added value of remdesivir was absent in Solidarity and DisCoVeRy.

• #51

  https://link.springer.com/article/10.1007/s11908-021-00769-8

  Monoclonal antibodies (mAbs) provide passive immunity against SARS-CoV-2 via direct administration of SARS-CoV-2 antibodies, resulting in a more rapid viral neutralization than occurs naturally upon viral exposure. […] The proposed primary benefit of convalescent plasma occurs via pathogen neutralization through antibodies; however, other mechanisms may exist as well. […] The largest RCT to-date was the UK-based RECOVERY trial. […] Based on the RECOVERY trial results, several other clinical trials were terminated early for ethical concerns regarding withholding corticosteroid treatment. […] Based on evidence from the REMAP-CAP and RECOVERY studies, tocilizumab is recommended in combination with corticosteroids in those recently hospitalized with rapidly increasing oxygen requirements and CRP75 mg/dL or within 24 h of ICU admission.

• #52 COVID-19 Treatment Clinical Care for Outpatients | COVID-19 | CDC

  https://www.cdc.gov/covid/hcp/clinical-care/outpatient-treatment.html

  When ritonavir-boosted nirmatrelvir or remdesivir are not accessible or clinically appropriate, the oral antiviral molnupiravir can be used. […] The U.S. Food and Drug Administration (FDA) has also issued an Emergency Use Authorization (EUA) to permit the emergency use of COVID-19 convalescent plasma with high titers of anti-SARS-CoV-2 antibodies for the treatment of COVID-19 in patients with immunosuppressive disease or receiving immunosuppressive treatment, in either the outpatient or inpatient setting. […] All patients with symptomatic COVID-19 should be offered symptom management with over-the-counter antipyretics, analgesics, or antitussives for fever, headache, myalgias, and cough. […] Pre-exposure prophylaxis (prevention) medication is available for some people who are moderately or severely immunocompromised for additional protection against COVID-19.

• #53 Types of COVID-19 Treatment | COVID-19 | CDC

  https://www.cdc.gov/covid/treatment/index.html

  Several treatment options are available for treating COVID-19. […] Nirmatrelvir with Ritonavir (Paxlovid) must begin within 5 days of when symptoms start. […] Veklury (remdesivir) must begin within 7 days of when symptoms start. […] Molnupiravir (Lagevrio) must begin within 5 days of when symptoms start. […] Some treatments might have side effects or interact with other medications you are taking. […] If you are hospitalized, your healthcare provider might use other types of medications, depending on how sick you are. […] If you have a weakened immune system, have received antiviral treatment, and continue to experience COVID-19 symptoms, your healthcare provider may recommend additional treatment, including convalescent plasma. […] COVID-19 oral antiviral treatments Paxlovid and Lagevrio are available for certain people at a lower cost. […] Talk to a healthcare provider about taking medications to treat COVID-19. […] The benefits of COVID-19 treatment outweigh the risk of rebound if you are at high risk for severe COVID-19.

• #54 COVID-19 drugs: Are there any that work?

  https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/coronavirus-drugs/faq-20485627

  The FDA has authorized the immune system suppression drug anakinra (Kineret) for people who need supplemental oxygen. And vilobelimab (Gohibic), a monoclonal antibody, was authorized by the FDA for people receiving mechanical ventilation or extracorporeal membrane oxygenation, called ECMO. […] The FDA also has authorized COVID-19 convalescent plasma therapy with high antibody levels to treat COVID-19. Convalescent plasma comes from blood donated by people who’ve recovered from COVID-19. It may be used to help people diagnosed with COVID-19 who have weakened immune systems. […] Claims that ivermectin, hydroxychloroquine or chloroquine can treat COVID-19 are false. These medicines are still useful for treating other illness. But only medicines approved or authorized by the FDA to treat COVID-19 are useful for that illness.

• #55 Use of Convalescent Plasma Therapy among Hospitalized Coronavirus Disease 2019 (COVID-19) Patients: A Single-Center Experience | medRxiv

  https://www.medrxiv.org/content/10.1101/2021.02.16.21251824v1

  COVID-19 Disease has strained our healthcare system. Convalescent plasma has been used to treat emerging infectious diseases -Influenza A/B, SARS-CoV, Ebola virus and now SARS-CoV 2. […] This study aims to determine the outcome and clinical course of COVID-19 patients who received convalescent plasma transfusion at Cardinal Santos Medical Center. […] Median time from admission to CP transfusion was 3 days. Majority of patients received additional therapies including dexamethasone (100%); Remdesivir (95%); antibiotics (100%), tocilizumab (65%); hemoperfusion (88%) or combination of these. […] There was improvement in the inflammatory markers (LDH pvalue 0.04, CRP pvalue 0.00, Ferritin pvalue 0.0001). There was improvement in the pulmonary parameters -increase in mean PaO2, mean SaO2, and mean PFR; and decrease in mean FiO2 and mean RR post-treatment. […] There was no significant difference in mortality and length of hospital stay in patients given CP vs controls. CP might have a role in the improvement of inflammatory markers and pulmonary status.

• #56

  https://link.springer.com/article/10.1007/s11908-021-00769-8

  Monoclonal antibodies (mAbs) provide passive immunity against SARS-CoV-2 via direct administration of SARS-CoV-2 antibodies, resulting in a more rapid viral neutralization than occurs naturally upon viral exposure. […] The proposed primary benefit of convalescent plasma occurs via pathogen neutralization through antibodies; however, other mechanisms may exist as well. […] The largest RCT to-date was the UK-based RECOVERY trial. […] Based on the RECOVERY trial results, several other clinical trials were terminated early for ethical concerns regarding withholding corticosteroid treatment. […] Based on evidence from the REMAP-CAP and RECOVERY studies, tocilizumab is recommended in combination with corticosteroids in those recently hospitalized with rapidly increasing oxygen requirements and CRP75 mg/dL or within 24 h of ICU admission.

• #57 COVID-19 Treatment Clinical Care for Outpatients | COVID-19 | CDC

  https://www.cdc.gov/covid/hcp/clinical-care/outpatient-treatment.html

  Pemivibart (Pemgarda) is a monoclonal antibody for COVID-19 pre-exposure prophylaxis in people who are moderately or severely immunocompromised and unlikely to mount an adequate immune response to COVID-19 vaccination and who meet the FDA-authorized conditions for use. […] Treatment benefits outweigh the risks of rebound for patients at higher risk for severe disease from COVID-19.

• #58 COVID-19 Medications – MN Dept. of Health

  https://www.health.state.mn.us/diseases/coronavirus/meds.html

  Remdesivir is an antiviral drug that works by blocking the virus from making copies of itself (replicating). Remdesivir is given through a needle in the vein (intravenously) over time, which is called an IV infusion. […] Remdesivir is approved for outpatient treatment of adults and children who are at high risk for severe COVID-19. It should be started as soon as possible, with outpatient treatment beginning within seven days of symptoms developing. […] There is currently one monoclonal antibody (pemivibart, Pemgarda) authorized for the prevention of serious illness from COVID-19 (pre-exposure prophylaxis), in conjunction with COVID-19 vaccines, in people who are immunocompromised and who are unlikely to respond to COVID-19 vaccination. […] COVID-19 vaccination is safe and effective before and during pregnancy and is the best protection against COVID-19 related illness.

• #59 Your Outpatient has Coronavirus Disease 2019: What Are the Treatment Options in the Current Severe Acute Respiratory Syndrome Coronavirus 2 Variant Climate? | Medicine Matters

  https://medicine-matters.blogs.hopkinsmedicine.org/2023/09/your-outpatient-has-coronavirus-disease-2019-what-are-the-treatment-options-in-the-current-severe-acute-respiratory-syndrome-coronavirus-2-variant-climate/

  Mutations accumulated by novel Severe Acute Respiratory Syndrome Coronavirus 2 Omicron sublineages contribute to evasion of previously effective monoclonal antibodies for treatment or prevention of Coronavirus Disease 2019 (COVID-19). […] Other authorized or approved antiviral drugs such as nirmatrelvir/ritonavir, remdesivir, and molnupiravir are, however, predicted to maintain activity against these sublineages and are key tools to reduce severe COVID-19 outcomes in vulnerable populations. […] A stepwise approach may be taken to target the appropriate antiviral drug to the appropriate patient, beginning with identifying whether a patient is at high risk for hospitalization or other complications of COVID-19. […] Among higher risk individuals, patient profile (including factors such as age, organ function, and comedications) and antiviral drug access inform suitable antiviral drug selection. […] When applied in targeted fashion, these therapies serve as a complement to vital ongoing nonpharmaceutical interventions and vaccination strategies that reduce morbidity and maximize protection against COVID-19.

• #60 COVID-19 – Wikipedia

  https://en.wikipedia.org/wiki/COVID-19

  The treatment and management of COVID-19 combines both supportive care, which includes treatment to relieve symptoms, fluid therapy, oxygen support as needed, and a growing list of approved medications. […] Most cases of COVID-19 are mild. In these, supportive care includes medication such as paracetamol or NSAIDs to relieve symptoms (fever, body aches, cough), proper intake of fluids, rest, and nasal breathing. […] As of November 2020 use of the glucocorticoid dexamethasone had been strongly recommended in those severe cases treated in hospital with low oxygen levels, to reduce the risk of death. […] Patients with mild to moderate symptoms who are in the risk groups can take nirmatrelvir/ritonavir (marketed as Paxlovid) or remdesivir, either of which reduces the risk of serious illness or hospitalization.

• #61 Coronavirus disease 2019 (COVID-19) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/coronavirus/diagnosis-treatment/drc-20479976

  Many people with COVID-19 recover with rest, plenty of fluids and care that manages symptoms. Medicine you can get without a prescription can help, such as: […] If you are at high risk of serious COVID-19 illness, your healthcare professional may suggest medicine to prevent mild illness from getting worse. These medicines can include nirmatrelvir and ritonavir (Paxlovid), remdesivir (Veklury) or molnupiravir (Lagevrio). […] If you’re very ill, you may need to be treated in the hospital. […] For people who are in the hospital for COVID-19 care, care is given based on a person’s immune system response and the need for oxygen support. […] Medicines for severe COVID-19 may be remdesivir, baricitinib (Olumiant) and tocilizumab (Actemra), or a corticosteroid such as dexamethasone. […] Another option may come from blood donated by people who have recovered from COVID-19, called convalescent plasma. The blood is processed to remove blood cells, leaving behind a liquid called plasma that has immune system proteins called antibodies. Convalescent plasma with high antibody levels may be used to help people with a weakened immune system recover from COVID-19.

• #62 COVID-19 Treatment Clinical Care for Outpatients | COVID-19 | CDC

  https://www.cdc.gov/covid/hcp/clinical-care/outpatient-treatment.html

  When ritonavir-boosted nirmatrelvir or remdesivir are not accessible or clinically appropriate, the oral antiviral molnupiravir can be used. […] The U.S. Food and Drug Administration (FDA) has also issued an Emergency Use Authorization (EUA) to permit the emergency use of COVID-19 convalescent plasma with high titers of anti-SARS-CoV-2 antibodies for the treatment of COVID-19 in patients with immunosuppressive disease or receiving immunosuppressive treatment, in either the outpatient or inpatient setting. […] All patients with symptomatic COVID-19 should be offered symptom management with over-the-counter antipyretics, analgesics, or antitussives for fever, headache, myalgias, and cough. […] Pre-exposure prophylaxis (prevention) medication is available for some people who are moderately or severely immunocompromised for additional protection against COVID-19.

• #63 Coronavirus disease 2019 (COVID-19) – Treatment algorithm | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/3000168/treatment-algorithm

  Acetaminophen or ibuprofen are recommended. […] Consider empiric antibiotics in patients with moderate disease only if there is clinical suspicion of secondary bacterial infection. […] Consider an antiviral agent. Options include nirmatrelvir/ritonavir, molnupiravir, and remdesivir. […] The World Health Organization strongly recommends nirmatrelvir/ritonavir in patients with nonsevere disease who are at high risk of hospitalization, and conditionally recommends nirmatrelvir/ritonavir in patients with nonsevere disease who are at moderate risk of hospitalization. […] In the UK, the National Institute for Health and Care Excellence (NICE) recommends nirmatrelvir/ritonavir or molnupiravir for patients who do not need supplemental oxygen, and are thought to be at high risk of progression to severe disease.

• #64 COVID-19 Treatment Clinical Care for Outpatients | COVID-19 | CDC

  https://www.cdc.gov/covid/hcp/clinical-care/outpatient-treatment.html

  When ritonavir-boosted nirmatrelvir or remdesivir are not accessible or clinically appropriate, the oral antiviral molnupiravir can be used. […] The U.S. Food and Drug Administration (FDA) has also issued an Emergency Use Authorization (EUA) to permit the emergency use of COVID-19 convalescent plasma with high titers of anti-SARS-CoV-2 antibodies for the treatment of COVID-19 in patients with immunosuppressive disease or receiving immunosuppressive treatment, in either the outpatient or inpatient setting. […] All patients with symptomatic COVID-19 should be offered symptom management with over-the-counter antipyretics, analgesics, or antitussives for fever, headache, myalgias, and cough. […] Pre-exposure prophylaxis (prevention) medication is available for some people who are moderately or severely immunocompromised for additional protection against COVID-19.

• #65 Coronavirus disease 2019 (COVID-19) – Treatment algorithm | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/3000168/treatment-algorithm

  If the patient is being managed in hospital, monitor patients closely for signs of clinical deterioration using medical early warning scores (e.g., National Early Warning Score 2 [NEWS2]), and respond immediately with appropriate supportive care interventions. […] For the management of cough, advise patients to avoid lying on their back as this makes coughing ineffective, and follow your local guidelines for treating acute cough. […] Advise patients about adequate nutrition and appropriate rehydration. Advise patients to drink fluids regularly to avoid dehydration. […] Provide basic mental health and psychosocial support for all patients, and manage any symptoms of insomnia, depression, or anxiety as appropriate. […] Consider treatment for olfactory dysfunction (e.g., olfactory training, intranasal corticosteroids) if it persists beyond 2 weeks.

• #66 Coronavirus disease 2019 (COVID-19) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/coronavirus/diagnosis-treatment/drc-20479976

  Many people with COVID-19 recover with rest, plenty of fluids and care that manages symptoms. Medicine you can get without a prescription can help, such as: […] If you are at high risk of serious COVID-19 illness, your healthcare professional may suggest medicine to prevent mild illness from getting worse. These medicines can include nirmatrelvir and ritonavir (Paxlovid), remdesivir (Veklury) or molnupiravir (Lagevrio). […] If you’re very ill, you may need to be treated in the hospital. […] For people who are in the hospital for COVID-19 care, care is given based on a person’s immune system response and the need for oxygen support. […] Medicines for severe COVID-19 may be remdesivir, baricitinib (Olumiant) and tocilizumab (Actemra), or a corticosteroid such as dexamethasone. […] Another option may come from blood donated by people who have recovered from COVID-19, called convalescent plasma. The blood is processed to remove blood cells, leaving behind a liquid called plasma that has immune system proteins called antibodies. Convalescent plasma with high antibody levels may be used to help people with a weakened immune system recover from COVID-19.

• #67

  https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/community_epidemiology/dc/2019-nCoV/Treatment.html

  Most people with COVID-19 have mild illness and can recover at home. You can treat symptoms with over-the-counter medicines to help you feel better. […] There are also treatments available that may help reduce how sick you become if you get COVID19. […] If you are sick with COVID-19, talk to your healthcare provider about treatment options. […] Dont delay! Treatment works best when started as early as possible (within 5-7 days after you first develop symptoms). […] The U.S. Food and Drug Administration has authorized, or approved, several antiviral medications. These medications treat mild to moderate COVID-19 in people who are more likely to get very sick. […] A healthcare provider will help decide which treatment, if any, is right for you. […] A healthcare provider or pharmacist must prescribe medications. […] You must start treatment within 5-7 days after you first develop symptoms. […] Treatment options include Nirmatrelvir with Ritonavir (Paxlovid), Remdesivir (Veklury), and Molnupiravir (Lagevrio).

• #68 COVID-19: Symptoms, incubation, prevention, and more

  https://www.medicalnewstoday.com/articles/covid-19

  There is no cure for COVID-19. […] There is no cure for COVID-19, but treatments can help relieve the symptoms. […] Seek immediate medical attention for: […] difficulty breathing […] persistent pain or pressure in the chest […] confusion […] an inability to stay awake […] a bluish tinge to the lips or face. […] At home, a person should: […] Get plenty of rest. […] Drink plenty of fluids. […] Have small, but frequent, nutritious meals. […] Take acetaminophen (Tylenol) to ease any pain and reduce a fever. […] Learn more about possible treatments for COVID-19.

• #69 Coronavirus disease 2019 (COVID-19) – Treatment algorithm | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/3000168/treatment-algorithm

  Evidence for the use of antivirals in patients with nonsevere disease is limited. […] Remdesivir was found to reduce the risk of hospitalization or death by 87% compared with placebo in nonhospitalized high-risk adults in a randomized, double-blind, placebo-controlled trial. […] The World Health Organization conditionally recommends the intravenous antiviral remdesivir in adults with severe disease. […] A Cochrane review found that tocilizumab reduced all-cause mortality at day 28 (high-certainty evidence) compared with standard care alone or placebo. […] The World Health Organization strongly recommends systemic corticosteroid therapy (low-dose intravenous or oral dexamethasone or hydrocortisone) for 7 to 10 days in adults with critical disease. […] Consider ECMO according to availability and expertise if the above methods fail.

• #70 Coronavirus disease 2019 (COVID-19) – Treatment algorithm | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/3000168/treatment-algorithm

  Evidence for the use of antivirals in patients with nonsevere disease is limited. […] Remdesivir was found to reduce the risk of hospitalization or death by 87% compared with placebo in nonhospitalized high-risk adults in a randomized, double-blind, placebo-controlled trial. […] The World Health Organization conditionally recommends the intravenous antiviral remdesivir in adults with severe disease. […] A Cochrane review found that tocilizumab reduced all-cause mortality at day 28 (high-certainty evidence) compared with standard care alone or placebo. […] The World Health Organization strongly recommends systemic corticosteroid therapy (low-dose intravenous or oral dexamethasone or hydrocortisone) for 7 to 10 days in adults with critical disease. […] Consider ECMO according to availability and expertise if the above methods fail.

• #71

  https://link.springer.com/article/10.1007/s11908-021-00769-8

  Baricitinib is an orally administered, reversible, selective inhibitor of JAK1/JAK2, hypothesized to have beneficial effects on acute respiratory distress syndrome (ARDS) and organ damage caused by SARS-CoV-2. […] Based on the data from ACTT-2 and COV-BARRIER, the NIH guideline, as of October 2021, recommends using baricitinib in combination with (1) dexamethasone alone or (2) dexamethasone plus remdesivir for patients who are recently hospitalized, on HFO or NIV, have rapidly increasing oxygen needs, and have increased markers of inflammation. […] The use of 12 to 16 h of prone ventilation is recommended for COVID-19 patients with moderate-to-severe ARDS requiring MV. […] This review has summarized the current state of COVID-19 therapeutic management based on available clinical trials and guidelines as of October 2021.

• #72 Coronavirus disease 2019 (COVID-19) – Treatment algorithm | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/3000168/treatment-algorithm

  Evidence for the use of antivirals in patients with nonsevere disease is limited. […] Remdesivir was found to reduce the risk of hospitalization or death by 87% compared with placebo in nonhospitalized high-risk adults in a randomized, double-blind, placebo-controlled trial. […] The World Health Organization conditionally recommends the intravenous antiviral remdesivir in adults with severe disease. […] A Cochrane review found that tocilizumab reduced all-cause mortality at day 28 (high-certainty evidence) compared with standard care alone or placebo. […] The World Health Organization strongly recommends systemic corticosteroid therapy (low-dose intravenous or oral dexamethasone or hydrocortisone) for 7 to 10 days in adults with critical disease. […] Consider ECMO according to availability and expertise if the above methods fail.

• #73 Coronavirus disease 2019 (COVID-19): MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/007768.htm

  If you are being cared for in the hospital and are receiving oxygen therapy, treatment for COVID-19 may include the following medicines: Remdesivir, an antiviral medicine, to help slow the virus. […] Dexamethasone, a steroid medicine, to help reduce an overactive immune response in the body. […] Based on available evidence, current treatment guidelines from the National Institutes of Health recommend against using some drugs for COVID-19, including chloroquine, hydroxychloroquine, and ivermectin.

• #74 IDSA Guidelines on the Treatment and Management of Patients with COVID-19

  https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/

  The guideline panel suggests against the routine use of anakinra among hospitalized patients with severe COVID-19. […] The guideline panel recommends against the use of either hydroxychloroquine alone or in combination with azithromycin in the hospital setting as higher certainty benefits (e.g., mortality reduction) are now highly unlikely even if additional high quality RCTs would become available. […] The guideline panel suggests against treatment with lopinavir/ritonavir across patient groups at risk for or with COVID-19. […] The guideline panel suggests against inhaled corticosteroids for the treatment of patients with mild-to-moderate COVID-19. […] The guideline panel recommends against ivermectin for the treatment of hospitalized patients with COVID-19. The guideline panel recommends against ivermectin for the treatment of outpatients with COVID-19.

• #75 COVID-19 drugs: Are there any that work?

  https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/coronavirus-drugs/faq-20485627

  Hydroxychloroquine and chloroquine are malaria medicines. Early in the pandemic, the FDA authorized these medicines for emergency use. But the FDA later withdrew that authorization. Clinical information showed that the medicines weren’t effective for treating COVID-19. They also can cause serious heart problems.

• #76 Coronavirus Disease 2019 (COVID-19) Treatment & Management: Approach Considerations, Medical Care, Complications

  https://emedicine.medscape.com/article/2500114-treatment

  Numerous collaborative efforts to discover and evaluate effectiveness of antivirals, immunotherapies, monoclonal antibodies, and vaccines have rapidly emerged. Guidelines and reviews of pharmacotherapy for COVID-19 have been published. […] The WHO developed a blueprint of potential therapeutic candidates in January 2020. The WHO’s SOLIDARITY trial, which began in January 2020, assessed various treatments for COVID-19. Initial findings in July 2020 showed that hydroxychloroquine, chloroquine, and lopinavir/ritonavir had little impact on reducing mortality compared to standard care. […] The urgent need for treatments during a pandemic can confound the interpretation of resulting outcomes of a therapy if data are not carefully collected and controlled. […] Evaluating emerging information on potential COVID-19 therapies has been challenging, but F. Perry Wilson provides a concise guide for clinicians to assess study evidence, using the example of a case series on hydroxychloroquine plus azithromycin.

• #77 IDSA Guidelines on the Treatment and Management of Patients with COVID-19

  https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/

  Patients who have these risk factors should be offered treatment with nirmatrelvir/ritonavir for 5 days (oral) or remdesivir for 3 days (intravenous). If these agents are not available or cannot be used then consider molnupiravir for 5 days (oral) or, if immunocompromised, high-titer convalescent plasma (intravenous) with activity against circulating variant. […] We recommend against the use of ivermectin outside of the context of a clinical trial given the low certainty of evidence for its benefit. […] Among hospitalized critically ill patients with COVID-19, the IDSA guideline panel recommends dexamethasone rather than no dexamethasone. […] The IL-6 inhibitors tocilizumab and sarilumab have shown a benefit in severe, but non-critical COVID-19 when used with corticosteroids. […] The guideline panel suggests baricitinib in addition to standard of care for patients hospitalized with severe COVID-19.

• #78 IDSA Guidelines on the Treatment and Management of Patients with COVID-19

  https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/

  The guideline panel suggests against the routine use of anakinra among hospitalized patients with severe COVID-19. […] The guideline panel recommends against the use of either hydroxychloroquine alone or in combination with azithromycin in the hospital setting as higher certainty benefits (e.g., mortality reduction) are now highly unlikely even if additional high quality RCTs would become available. […] The guideline panel suggests against treatment with lopinavir/ritonavir across patient groups at risk for or with COVID-19. […] The guideline panel suggests against inhaled corticosteroids for the treatment of patients with mild-to-moderate COVID-19. […] The guideline panel recommends against ivermectin for the treatment of hospitalized patients with COVID-19. The guideline panel recommends against ivermectin for the treatment of outpatients with COVID-19.

• #79 COVID-19 drugs: Are there any that work?

  https://www.mayoclinic.org/diseases-conditions/coronavirus/expert-answers/coronavirus-drugs/faq-20485627

  The FDA has authorized the immune system suppression drug anakinra (Kineret) for people who need supplemental oxygen. And vilobelimab (Gohibic), a monoclonal antibody, was authorized by the FDA for people receiving mechanical ventilation or extracorporeal membrane oxygenation, called ECMO. […] The FDA also has authorized COVID-19 convalescent plasma therapy with high antibody levels to treat COVID-19. Convalescent plasma comes from blood donated by people who’ve recovered from COVID-19. It may be used to help people diagnosed with COVID-19 who have weakened immune systems. […] Claims that ivermectin, hydroxychloroquine or chloroquine can treat COVID-19 are false. These medicines are still useful for treating other illness. But only medicines approved or authorized by the FDA to treat COVID-19 are useful for that illness.

• #80 IDSA Guidelines on the Treatment and Management of Patients with COVID-19

  https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/

  The guideline panel suggests against the routine use of anakinra among hospitalized patients with severe COVID-19. […] The guideline panel recommends against the use of either hydroxychloroquine alone or in combination with azithromycin in the hospital setting as higher certainty benefits (e.g., mortality reduction) are now highly unlikely even if additional high quality RCTs would become available. […] The guideline panel suggests against treatment with lopinavir/ritonavir across patient groups at risk for or with COVID-19. […] The guideline panel suggests against inhaled corticosteroids for the treatment of patients with mild-to-moderate COVID-19. […] The guideline panel recommends against ivermectin for the treatment of hospitalized patients with COVID-19. The guideline panel recommends against ivermectin for the treatment of outpatients with COVID-19.

• #81 IDSA Guidelines on the Treatment and Management of Patients with COVID-19

  https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/

  The guideline panel suggests against the routine use of anakinra among hospitalized patients with severe COVID-19. […] The guideline panel recommends against the use of either hydroxychloroquine alone or in combination with azithromycin in the hospital setting as higher certainty benefits (e.g., mortality reduction) are now highly unlikely even if additional high quality RCTs would become available. […] The guideline panel suggests against treatment with lopinavir/ritonavir across patient groups at risk for or with COVID-19. […] The guideline panel suggests against inhaled corticosteroids for the treatment of patients with mild-to-moderate COVID-19. […] The guideline panel recommends against ivermectin for the treatment of hospitalized patients with COVID-19. The guideline panel recommends against ivermectin for the treatment of outpatients with COVID-19.

• #82 IDSA Guidelines on the Treatment and Management of Patients with COVID-19

  https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/

  The guideline panel suggests against the routine use of anakinra among hospitalized patients with severe COVID-19. […] The guideline panel recommends against the use of either hydroxychloroquine alone or in combination with azithromycin in the hospital setting as higher certainty benefits (e.g., mortality reduction) are now highly unlikely even if additional high quality RCTs would become available. […] The guideline panel suggests against treatment with lopinavir/ritonavir across patient groups at risk for or with COVID-19. […] The guideline panel suggests against inhaled corticosteroids for the treatment of patients with mild-to-moderate COVID-19. […] The guideline panel recommends against ivermectin for the treatment of hospitalized patients with COVID-19. The guideline panel recommends against ivermectin for the treatment of outpatients with COVID-19.

• #83 IDSA Guidelines on the Treatment and Management of Patients with COVID-19

  https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/

  The guideline panel suggests against famotidine for the sole purpose of treating COVID-19. […] The guideline panel recommends against colchicine for the treatment of hospitalized patients with COVID-19. The guideline panel suggests against colchicine for the treatment of ambulatory persons with COVID-19.

• #84 IDSA Guidelines on the Treatment and Management of Patients with COVID-19

  https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/

  The guideline panel suggests against famotidine for the sole purpose of treating COVID-19. […] The guideline panel recommends against colchicine for the treatment of hospitalized patients with COVID-19. The guideline panel suggests against colchicine for the treatment of ambulatory persons with COVID-19.

• #85 COVID-19 Medications – MN Dept. of Health

  https://www.health.state.mn.us/diseases/coronavirus/meds.html

  The use of antiviral treatments for COVID-19 when you are pregnant or breastfeeding is supported by the National Institutes of Health (NIH), the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal Fetal Medicine (SMFM). COVID-19 treatment should not be withheld from you just because you are pregnant or breastfeeding. […] Paxlovid is the preferred treatment option for mild to moderate COVID-19 in people who are not hospitalized. It may be used when you are pregnant or breastfeeding. […] Remdesivir can be taken if you are pregnant or breastfeeding if your doctor thinks it is right for your situation.

• #86 COVID-19 Medications – MN Dept. of Health

  https://www.health.state.mn.us/diseases/coronavirus/meds.html

  The use of antiviral treatments for COVID-19 when you are pregnant or breastfeeding is supported by the National Institutes of Health (NIH), the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal Fetal Medicine (SMFM). COVID-19 treatment should not be withheld from you just because you are pregnant or breastfeeding. […] Paxlovid is the preferred treatment option for mild to moderate COVID-19 in people who are not hospitalized. It may be used when you are pregnant or breastfeeding. […] Remdesivir can be taken if you are pregnant or breastfeeding if your doctor thinks it is right for your situation.

• #87 COVID-19 Medications – MN Dept. of Health

  https://www.health.state.mn.us/diseases/coronavirus/meds.html

  The use of antiviral treatments for COVID-19 when you are pregnant or breastfeeding is supported by the National Institutes of Health (NIH), the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal Fetal Medicine (SMFM). COVID-19 treatment should not be withheld from you just because you are pregnant or breastfeeding. […] Paxlovid is the preferred treatment option for mild to moderate COVID-19 in people who are not hospitalized. It may be used when you are pregnant or breastfeeding. […] Remdesivir can be taken if you are pregnant or breastfeeding if your doctor thinks it is right for your situation.

• #88 Types of COVID-19 Treatment | COVID-19 | CDC

  https://www.cdc.gov/covid/treatment/index.html

  Several treatment options are available for treating COVID-19. […] Nirmatrelvir with Ritonavir (Paxlovid) must begin within 5 days of when symptoms start. […] Veklury (remdesivir) must begin within 7 days of when symptoms start. […] Molnupiravir (Lagevrio) must begin within 5 days of when symptoms start. […] Some treatments might have side effects or interact with other medications you are taking. […] If you are hospitalized, your healthcare provider might use other types of medications, depending on how sick you are. […] If you have a weakened immune system, have received antiviral treatment, and continue to experience COVID-19 symptoms, your healthcare provider may recommend additional treatment, including convalescent plasma. […] COVID-19 oral antiviral treatments Paxlovid and Lagevrio are available for certain people at a lower cost. […] Talk to a healthcare provider about taking medications to treat COVID-19. […] The benefits of COVID-19 treatment outweigh the risk of rebound if you are at high risk for severe COVID-19.

• #89 COVID-19 Medications – MN Dept. of Health

  https://www.health.state.mn.us/diseases/coronavirus/meds.html

  Remdesivir is an antiviral drug that works by blocking the virus from making copies of itself (replicating). Remdesivir is given through a needle in the vein (intravenously) over time, which is called an IV infusion. […] Remdesivir is approved for outpatient treatment of adults and children who are at high risk for severe COVID-19. It should be started as soon as possible, with outpatient treatment beginning within seven days of symptoms developing. […] There is currently one monoclonal antibody (pemivibart, Pemgarda) authorized for the prevention of serious illness from COVID-19 (pre-exposure prophylaxis), in conjunction with COVID-19 vaccines, in people who are immunocompromised and who are unlikely to respond to COVID-19 vaccination. […] COVID-19 vaccination is safe and effective before and during pregnancy and is the best protection against COVID-19 related illness.

• #90 COVID-19 Medications – MN Dept. of Health

  https://www.health.state.mn.us/diseases/coronavirus/meds.html

  Remdesivir is an antiviral drug that works by blocking the virus from making copies of itself (replicating). Remdesivir is given through a needle in the vein (intravenously) over time, which is called an IV infusion. […] Remdesivir is approved for outpatient treatment of adults and children who are at high risk for severe COVID-19. It should be started as soon as possible, with outpatient treatment beginning within seven days of symptoms developing. […] There is currently one monoclonal antibody (pemivibart, Pemgarda) authorized for the prevention of serious illness from COVID-19 (pre-exposure prophylaxis), in conjunction with COVID-19 vaccines, in people who are immunocompromised and who are unlikely to respond to COVID-19 vaccination. […] COVID-19 vaccination is safe and effective before and during pregnancy and is the best protection against COVID-19 related illness.

• #91 COVID-19 Medications – MN Dept. of Health

  https://www.health.state.mn.us/diseases/coronavirus/meds.html

  People with risk factors for severe illness with COVID-19, such as older age or underlying health conditions, may benefit from COVID-19 antiviral medications. These treatments can help prevent severe illness, hospitalization, and death from COVID-19. […] COVID-19 medications are not a substitute for prevention. It is still recommended that everyone who is eligible get vaccinated and take other steps to prevent the spread of COVID-19. […] Not everyone with COVID-19 needs to get treated. Antiviral treatments for COVID-19 are available for patients with mild to moderate symptoms, who are not in the hospital, who have had symptoms for seven days or less, and who are at high risk for severe illness. […] COVID-19 medications may be available for free or at low cost. Ask your health care provider (such as your doctor) or pharmacist if you are eligible for a patient assistance program to help pay for your medications.

• #92 COVID-19: Healthcare Providers| Coronavirus Disease 2019 (COVID-19) | Airborne Disease Surveillance Epidemiology Program | MeCDC | Maine DHHS

  https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/coronavirus/providers.shtml

  As of December 2023, COVID-19 antivirals are now distributed via commercial channels. Most patients will still be able to access Paxlovid and Lagevrio through retail pharmacies or certain health care facilities as they had in the past. […] Paxlovid (nirmatrelvir-ritonavir): Medicare, Medicaid (MaineCare), and uninsured patients can get Paxlovid for free through 2024 via Pfizer’s U.S. Government Patient Assistance Program (USG PAP). […] Lagevrio (molnupiravir): The Merck Patient Assistance Program provides Lagevrio free of charge to patients who meet its eligibility criteria and who, without assistance, could not otherwise afford the product.

• #93 Commercialization of COVID-19 Vaccines, Treatments, and Tests: Implications for Access and Coverage | KFF

  https://www.kff.org/coronavirus-covid-19/issue-brief/commercialization-of-covid-19-vaccines-treatments-and-tests-implications-for-access-and-coverage/

  However, in the case of Paxlovid, the federal government announced that those who are uninsured will have free access to federally-procured Paxlovid through 2024, via a patient assistance program and thereafter, the manufacturer (Pfizer) will run a patient assistance program to provide free Paxlovid to uninsured individuals through 2028.

• #94 COVID-19: Healthcare Providers| Coronavirus Disease 2019 (COVID-19) | Airborne Disease Surveillance Epidemiology Program | MeCDC | Maine DHHS

  https://www.maine.gov/dhhs/mecdc/infectious-disease/epi/airborne/coronavirus/providers.shtml

  As of December 2023, COVID-19 antivirals are now distributed via commercial channels. Most patients will still be able to access Paxlovid and Lagevrio through retail pharmacies or certain health care facilities as they had in the past. […] Paxlovid (nirmatrelvir-ritonavir): Medicare, Medicaid (MaineCare), and uninsured patients can get Paxlovid for free through 2024 via Pfizer’s U.S. Government Patient Assistance Program (USG PAP). […] Lagevrio (molnupiravir): The Merck Patient Assistance Program provides Lagevrio free of charge to patients who meet its eligibility criteria and who, without assistance, could not otherwise afford the product.

• #95 Types of COVID-19 Treatment | COVID-19 | CDC

  https://www.cdc.gov/covid/treatment/index.html

  If you have COVID-19 and are more likely to get very sick, medications are available that can reduce your risk of hospitalization and death. […] Don’t delay: Treatments must be started within 5-7 days after you first develop symptoms to be effective. […] Treatment must be started within 5-7 days of when your symptoms first start. You do not need a positive test to start treatment so if you get sick and are at high risk for severe illness, talk to your healthcare provider as soon as possible. […] FDA has authorized or approved several antiviral medications used to treat mild to moderate COVID-19 in people who are more likely to get very sick. […] Antiviral medications target specific parts of the virus to stop it from multiplying in the body once someone is infected, helping to prevent severe illness and death.

• #96 COVID-19 Treatment Clinical Care for Outpatients | COVID-19 | CDC

  https://www.cdc.gov/covid/hcp/clinical-care/outpatient-treatment.html

  Clinicians should consider COVID-19 treatment in patients with mild or moderate COVID-19 who have one or more risk factors for severe COVID-19 to reduce progression to hospitalization and death. […] Treatment must be started as soon as possible and within 5-7 days of symptom onset. […] Patients who are at higher risk for severe COVID-19 might benefit from outpatient treatment. […] To minimize delays in antiviral treatment for patients at higher risk for severe COVID-19, use a nucleic acid amplification test (NAAT), such as a PCR test, when possible, for reliable diagnosis. […] In a clinical trial, ritonavir-boosted nirmatrelvir reduced the risk of hospitalization and death by 87% in unvaccinated outpatients with COVID-19 at higher risk of severe disease. […] Remdesivir (Veklury) reduced the risk of hospitalization and death by 87% in unvaccinated outpatients with COVID-19 who are at higher risk of severe disease.

• #97 IDSA Guidelines on the Treatment and Management of Patients with COVID-19

  https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/

  Patients who have these risk factors should be offered treatment with nirmatrelvir/ritonavir for 5 days (oral) or remdesivir for 3 days (intravenous). If these agents are not available or cannot be used then consider molnupiravir for 5 days (oral) or, if immunocompromised, high-titer convalescent plasma (intravenous) with activity against circulating variant. […] We recommend against the use of ivermectin outside of the context of a clinical trial given the low certainty of evidence for its benefit. […] Among hospitalized critically ill patients with COVID-19, the IDSA guideline panel recommends dexamethasone rather than no dexamethasone. […] The IL-6 inhibitors tocilizumab and sarilumab have shown a benefit in severe, but non-critical COVID-19 when used with corticosteroids. […] The guideline panel suggests baricitinib in addition to standard of care for patients hospitalized with severe COVID-19.

• #98 :: JKMS :: Journal of Korean Medical Science

  https://jkms.org/DOIx.php?id=10.3346/jkms.2022.37.e352

  The coronavirus disease 2019 (COVID-19) continues to threaten public health in Korea although several surges have passed in the past 3 years since 2019. […] Although patients with mild-to-moderate COVID-19 can usually recover at home, antiviral therapy to prevent disease progression and hospitalization is beneficial for those at high risk of progressing to severe COVID-19. […] Several evidence-based treatment guidelines have been developed in Korea, including those derived from domestic studies. […] Currently, three types of antiviral agents nirmatrelvir-ritonavir, molnupiravir, and remdesivir are available in Korea to treat severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. […] For most individuals, nirmatrelvir/ritonavir is preferred because of its high efficacy and convenience of administration.

• #99 Therapeutic strategies for COVID-19: progress and lessons learned | Nature Reviews Drug Discovery

  https://www.nature.com/articles/s41573-023-00672-y

  The coronavirus disease 2019 (COVID-19) pandemic has stimulated tremendous efforts to develop therapeutic strategies that target severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and/or human proteins to control viral infection, encompassing hundreds of potential drugs and thousands of patients in clinical trials. So far, a few small-molecule antiviral drugs (nirmatrelvir-ritonavir, remdesivir and molnupiravir) and 11 monoclonal antibodies have been marketed for the treatment of COVID-19, mostly requiring administration within 10 days of symptom onset. In addition, hospitalized patients with severe or critical COVID-19 may benefit from treatment with previously approved immunomodulatory drugs, including glucocorticoids such as dexamethasone, cytokine antagonists such as tocilizumab and Janus kinase inhibitors such as baricitinib.

• #100 COVID-19: Management in hospitalized adults – UpToDate

  https://www.uptodate.com/contents/covid-19-management-in-hospitalized-adults

  COVID-19: Management in hospitalized adults […] This topic will discuss the management of COVID-19 in hospitalized adults. […] Guidance has been issued by the World Health Organization and, in the United States, by the National Institutes of Health COVID-19 Treatment Guidelines Panel. […] COVID-19-SPECIFIC THERAPY […] Specific treatments […] Dexamethasone and other glucocorticoids […] Adjunctive immunomodulators […] Baricitinib and JAK inhibitors […] IL-6 pathway inhibitors (eg, tocilizumab) […] Limited roles for alternative immunomodulators […] Remdesivir […] Limited role for antibody-based therapies (monoclonal antibodies and convalescent plasma).

• #101 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20250430/New-antiviral-compounds-show-broad-protection-against-COVID-19-variants.aspx

  AVI-4773 and related MPro inhibitors outperform existing treatments like nirmatrelvir in preclinical studies, offering a promising path toward pan-coronavirus therapies. […] Nirmatrelvir and ensitrelvir, for example, are main protease (Mpro) inhibitors that are currently approved for the clinical treatment of COVID-19. […] A recent study published in Science Advances reports the recent discovery of Mpro inhibitors that exhibit broad activity against SARS-CoV-2 and other coronaviruses. […] Mouse in vivo studies demonstrated powerful antiviral activity of AVI-4516 against the SARS-CoV-2 Beta variant of concern (VOC). […] Most analogs lost activity against nirmatrelvir-resistant mutants; however, AVI-4516 remained highly potent against the SARS-CoV-2 E166Q variant. […] AVI-4773 reduced viral titers to undetectable levels after three doses, which is a three-log reduction in viral load as compared to ensitrelvir treatment.

• #102 Therapeutic strategies for COVID-19: progress and lessons learned | Nature Reviews Drug Discovery

  https://www.nature.com/articles/s41573-023-00672-y

  Molnupiravir was first approved in the UK in November 2021 and has been marketed in many countries since then. In 2022, the platform-adaptive PANORAMIC trial reported no benefit of molnupiravir plus usual care in reducing COVID-19-associated hospitalizations or deaths among high-risk vaccinated adults within 5 days of symptom onset. […] Effective treatment strategies that can be inexpensively and conveniently applied are still needed to tackle COVID-19, including those that can address drug resistance conferred by emerging variants, for which combination therapies could be explored. The development of pan-coronavirus inhibitors and their combinations, ideally delivered orally or by inhalation, could be valuable in combating SARS-CoV-2 variants, and the availability of such therapies would be highly desirable in preparation for future outbreaks of pathogenic coronaviruses.

• #103 Therapeutic strategies for COVID-19: progress and lessons learned | Nature Reviews Drug Discovery

  https://www.nature.com/articles/s41573-023-00672-y

  Molnupiravir was first approved in the UK in November 2021 and has been marketed in many countries since then. In 2022, the platform-adaptive PANORAMIC trial reported no benefit of molnupiravir plus usual care in reducing COVID-19-associated hospitalizations or deaths among high-risk vaccinated adults within 5 days of symptom onset. […] Effective treatment strategies that can be inexpensively and conveniently applied are still needed to tackle COVID-19, including those that can address drug resistance conferred by emerging variants, for which combination therapies could be explored. The development of pan-coronavirus inhibitors and their combinations, ideally delivered orally or by inhalation, could be valuable in combating SARS-CoV-2 variants, and the availability of such therapies would be highly desirable in preparation for future outbreaks of pathogenic coronaviruses.

• #104 Therapeutic strategies for COVID-19: progress and lessons learned | Nature Reviews Drug Discovery

  https://www.nature.com/articles/s41573-023-00672-y

  Molnupiravir was first approved in the UK in November 2021 and has been marketed in many countries since then. In 2022, the platform-adaptive PANORAMIC trial reported no benefit of molnupiravir plus usual care in reducing COVID-19-associated hospitalizations or deaths among high-risk vaccinated adults within 5 days of symptom onset. […] Effective treatment strategies that can be inexpensively and conveniently applied are still needed to tackle COVID-19, including those that can address drug resistance conferred by emerging variants, for which combination therapies could be explored. The development of pan-coronavirus inhibitors and their combinations, ideally delivered orally or by inhalation, could be valuable in combating SARS-CoV-2 variants, and the availability of such therapies would be highly desirable in preparation for future outbreaks of pathogenic coronaviruses.

• #105

  https://journals.lww.com/md-journal/fulltext/2025/05020/traditional_chinese_medicine_for_post_covid__a.43.aspx

  Post-COVID syndrome affects at least 10% of individuals recovering from COVID-19. Currently, there is no causal treatment. This retrospective cohort study aimed to evaluate the potential of traditional Chinese medicine (TCM) in treating post-COVID symptoms. […] TCM treatment was associated with significant improvements in post-COVID symptoms, warranting further evaluation through randomized controlled studies. […] The aim of this study was to evaluate the effectiveness of TCM approaches for the treatment of post-COVID conditions. […] Most patients received acupuncture (n=66; 84%) and Chinese pharmacological treatment (n=61; 77%). […] Following TCM treatment, most of the reported post-COVID complaints significantly decreased. […] The results of this study highlight that TCM treatment was associated with significant improvements in fatigue and cognitive impairment among the subgroup of patients initially unable to work due to these symptoms. […] In conclusion, the present study results suggest that TCM treatments focusing on acupuncture and Chinese pharmacotherapy could be helpful for a wide range of post-COVID symptoms, including mental, neurological, cardiovascular, and musculoskeletal conditions.

• #106

  https://www.who.int/emergencies/diseases/novel-coronavirus-2019/treatments

  As COVID-19 continues to affect people around the world, researchers are racing to develop effective treatments to help save lives, improve the health outcomes for patients and lessen the burden on health systems. […] Several therapeutics have been approved by WHO to help patients, and several others are in the development, testing or review process. […] WHO, through its COVID-19 Solidarity Therapeutics Trial, is coordinating global efforts to find drugs and other therapies that can save lives for those with severe or critical COVID-19. […] Although health care options for patients with COVID-19 are improving, we must continue to follow public health guidance to prevent the spread of the disease, including wearing properly fitted masks, cleaning our hands, ensuring good ventilation indoors, physically distancing and avoiding crowds. Getting vaccinated against COVID-19 as soon as its your turn is the best way to reduce your risk of contracting the disease or developing severe symptoms.

• #107 Coronavirus Disease (COVID-19): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/21214-coronavirus-covid-19

  COVID can be treated with antiviral medications. These include nirmatrelvir/ritonavir (Paxlovid), remdesivir (Veklury) and molnupiravir (Lagevrio). When taken within the first five days, antivirals can help you feel better and reduce your risk of severe illness and long COVID. […] If you’re severely ill and hospitalized, your healthcare provider might treat you with: Monoclonal antibody treatment, Supplemental oxygen, Corticosteroids, Mechanical ventilation. […] Making sure you’re up to date with a current COVID vaccine is the best way to reduce your risk of getting sick with COVID and reduce your risk of severe illness if you do get sick. You’re also less likely to get long COVID if you’re vaccinated. […] Vaccinations and antiviral medications can help reduce your risk of severe illness.

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