What's New in the Guidelines
Last Updated: July 17, 2020
Key Updates to the Guidelines
Remdesivir
In situations where remdesivir supplies are limited, the COVID-19 Treatment Guidelines Panel (the Panel) recommends prioritizing remdesivir for use in hospitalized patients with COVID-19 who require supplemental oxygen but who are not mechanically ventilated or on extracorporeal membrane oxygenation (BI). The overall recommendations for the use of remdesivir are being revised and will be updated soon.
Corticosteroids (Including Dexamethasone)
The Corticosteroids (Including Dexamethasone) section is a new subsection of Immunomodulators Under Evaluation for Treatment of COVID-19. This new section is based on the Recommendations for Dexamethasone in Patients with COVID-19 section that was released on June 25, 2020. The Panel continues to recommend the use of dexamethasone in patients who are mechanically ventilated (AI) and in patients who require supplemental oxygen but who are not mechanically ventilated (BI). The new Corticosteroids (Including Dexamethasone) section also discusses the clinical data on the use of other corticosteroids in patients with COVID-19, the potential adverse effects of corticosteroids, other considerations when using corticosteroids, and recommendations for the use of dexamethasone in pregnant patients.
New Sections of the Guidelines
Mesenchymal Stem Cells
A new subsection on mesenchymal stem cells was added to Immune-Based Therapy in the Blood-Derived Products Under Evaluation for the Treatment of COVID-19 section. The Panel recommends against the use of mesenchymal stem cells for the treatment of COVID-19, except in a clinical trial (AII).
Adjunctive Therapy: Vitamin C, Vitamin D, and Zinc Supplementation
Vitamin and mineral supplements have been promoted for the treatment and prevention of respiratory viral infections; however, their roles in treating COVID-19 are yet unproven. Three new sections were added to the guidelines to discuss the proposed rationale for the use of vitamin C, vitamin D, and zinc supplements.
Special Considerations in Solid Organ Transplant, Hematopoietic Stem Cell Transplant, and Cellular Therapy Candidates, Donors, and Recipients
Solid organ transplant, hematopoietic stem cell transplant, and cellular therapy donors and recipients are at risk of complications associated with COVID-19. This new section provides recommendations for screening transplant candidates and donors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection before donation and transplant. Clinicians should follow the guidelines for evaluating and managing COVID-19 in nontransplant patients when treating transplant and cellular therapy recipients (AIII). In this section, the Panel also emphasizes the importance of consulting a transplant specialist and reviewing concomitant medications for drug-drug interactions and overlapping toxicities.
Other Updates to the Guidelines
Introduction
The Panel has expanded the explanation of the types of recommendation statements used in the guidelines.
Overview of COVID-19 : Epidemiology, Clinical Presentation, and Transmission
The section has been updated with recent epidemiologic data on COVID-19 in the United States. Emerging evidence suggests that racial and ethnic minorities in the United States experience higher rates of COVID-19 and subsequent hospitalization and death.
Prevention and Prophylaxis of SARS-CoV-2 Infection
This section discusses general prevention measures for reducing the risk of acquisition and transmission of SARS-CoV-2, the types of vaccines that are currently being studied, and the drug therapies that are being investigated for pre-exposure and post-exposure prophylaxis.
Hydroxychloroquine Plus Azithromycin
New clinical data from a large, retrospective, observational study have been added to this section and Table 2A. There is no change to the Panel’s recommendation.
Lopinavir/Ritonavir and Other HIV Protease Inhibitors
New data on lopinavir/ritonavir pharmacokinetics in patients with COVID-19 and new data on combination therapy with lopinavir/ritonavir plus interferon beta-1b plus ribavirin for the treatment of COVID-19 have been added to this section and Table 2A. There is no change to the Panel’s recommendation.
Blood-Derived Products Under Evaluation for the Treatment of COVID-19
New clinical data have been added to the Convalescent Plasma section. A new section has been created for SARS-CoV-2-specific immunoglobulins. There are no changes to the Panel’s recommendations.
Immunomodulators Under Evaluation for the Treatment of COVID-19
New clinical data for interferon beta-1b were added to the Interferons (Alfa, Beta) section, and the Panel changed the recommendation for interferons: The Panel recommends against the use of interferons for the treatment of severe and critically ill COVID-19 patients, except in a clinical trial (AIII). There are insufficient data to recommend either for or against the use of interferon-beta for the treatment of early (<7 and="" covid-19.="" days="" from="" mild="" moderate="" onset="" p="" symptom="">
The Kinase Inhibitors section was expanded to include additional Janus kinase (JAK) inhibitors and to include Bruton’s tyrosine kinase (BTK) inhibitors. The Panel recommends against the use of BTK inhibitors and JAK inhibitors for the treatment of COVID-19, except in a clinical trial (AIII).
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