Treatments of Interest for COVID-19
Full update June 2023
The chart below provides information or resources on pharmacotherapy of interest for COVID-19, the disease caused by the SARS-CoV-2 virus. Additional resources on pharmacotherapy, supportive therapy, and vaccines, many of which are frequently updated, include:
- American Society of Health-System Pharmacists COVID-19 resource center (https://www.ashp.org/covid-19).
- British Columbia Ministry of Health guidance on current research on COVID-19 treatments (http://www.bccdc.ca/health-professionals/clinical-resources/covid-19-care/clinical-care/treatments).
- NIH general treatment guidelines (https://covid19treatmentguidelines.nih.gov/).
- NIH guidance for choosing outpatient treatments (https://www.covid19treatmentguidelines.nih.gov/tables/therapeutic-management-of-nonhospitalized-adults/).
- IDSA treatment and management guidelines (https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/).
- WHO guidance on drugs for COVID-19 (https://www.bmj.com/content/370/bmj.m3379).
- Surviving Sepsis Campaign COVID-19 guidelines (https://sccm.org/SurvivingSepsisCampaign/Guidelines/COVID-19).
- Ontario’s COVID-19 Science Briefs website: https://covid19-sciencetable.ca/science-briefs/#infectious-diseases-clinical-care.
For guidance from the USP on sterile compounding during the pandemic, including preparation of COVID-19 treatments such as monoclonal antibodies, see https://www.usp.org/compounding.
Drug |
Pertinent Information or Resources Note that DOSES provided are examples only for ADULTS. |
TREATMENTS WITH THE BEST EVIDENCE |
|
Corticosteroids, systemic |
|
IL-6 antagonists |
Tocilizumab (Actemra)
Sarilumab (Kevzara)
|
Janus kinase inhibitors |
Baricitinib (Olumiant)
Tofacitinib (Xeljanz)
|
Molnupiravir (Lagevrio) |
|
Nirmatrelvir/ ritonavir (Paxlovid) |
|
Remdesivir (Veklury) |
|
TREATMENTS WITH LIMITED OR EMERGING EVIDENCE |
|
Anakinra (Kineret) |
|
Colchicine, outpatients |
|
Convalescent plasma (COVID-19), high-titer |
|
Corticosteroids, inhaled |
|
Vilobelimab (Gohibic) |
|
TREATMENTS WITH NO CLINICALLY IMPORTANT BENEFIT |
|
Colchicine, inpatients |
|
Famotidine |
|
Fluvoxamine |
|
Hydroxy-chloroquine/ chloroquine |
|
Ivermectin |
|
Metformin |
|
Vitamin C, vitamin D, zinc |
|
Abbreviations: ALT = alanine aminotransferase; CV = cardiovascular; ECMO = extracorporeal membrane oxygenation; EUA = Emergency Use Authorization; ICU = intensive care unit; RDA = Recommended Daily Allowance; suPAR = plasma soluble urokinase plasminogen activator receptor; ULN = upper limit of normal.
Levels of Evidence
In accordance with our goal of providing Evidence-Based information, we are citing the LEVEL OF EVIDENCE for the clinical recommendations we publish.
Level |
Definition |
Study Quality |
A |
Good-quality patient-oriented evidence.* |
|
B |
Inconsistent or limited-quality patient-oriented evidence.* |
|
C |
Consensus; usual practice; expert opinion; disease-oriented evidence (e.g., physiologic or surrogate endpoints); case series for studies of diagnosis, treatment, prevention, or screening. |
*Outcomes that matter to patients (e.g., morbidity, mortality, symptom improvement, quality of life).
[Adapted from Ebell MH, Siwek J, Weiss BD, et al. Strength of Recommendation Taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature. Am Fam Physician 2004;69:548-56. https://www.aafp.org/pubs/afp/issues/2004/0201/p548.html.]
References
- NIH. Coronavirus disease 2019 (COVID-19). Treatment guidelines. Last updated May 2, 2023. https://covid19treatmentguidelines.nih.gov/. (Accessed May 9, 2023).
- Infectious Diseases Society of America guidelines on the treatment and management of patients with COVID-19. Last updated May 15, 2023. https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/. (Accessed May 26, 2023).
- RECOVERY Collaborative Group, Horby P, Lim WS, et al. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021 Feb 25;384(8):693-704.
- Angus DC, Derde L, Al-Beidh F, et al. Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial. JAMA. 2020 Oct 6;324(13):1317-1329.
- Tomazini BM, Maia IS, Cavalcanti AB, et al. Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients With Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19: The CoDEX Randomized Clinical Trial. JAMA. 2020 Oct 6;324(13):1307-1316.
- Dequin PF, Heming N, Meziani F, et al. CAPE COVID Trial Group and the CRICS-TriGGERSep Network. Effect of Hydrocortisone on 21-Day Mortality or Respiratory Support Among Critically Ill Patients With COVID-19: A Randomized Clinical Trial. JAMA. 2020 Oct 6;324(13):1298-1306.
- Jeronimo CMP, Farias MEL, Val FFA, et al. Methylprednisolone as Adjunctive Therapy for Patients Hospitalized With Coronavirus Disease 2019 (COVID-19; Metcovid): A Randomized, Double-blind, Phase IIb, Placebo-controlled Trial. Clin Infect Dis. 2021 May 4;72(9):e373-e381.
- WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group, Sterne JAC, Murthy S, et al. Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis. JAMA. 2020 Oct 6;324(13):1330-1341.
- RECOVERY Collaborative Group. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet. 2021 May 1;397(10285):1637-1645.
- Product information for Actemra. Genentech. South San Francisco, CA 94080. December 2022.
- Rosas IO, Bräu N, Waters M, et al. Tocilizumab in Hospitalized Patients with Severe Covid-19 Pneumonia. N Engl J Med. 2021 Apr 22;384(16):1503-1516.
- REMAP-CAP Investigators; Gordon AC, Mouncey PR, et al. Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19. N Engl J Med. 2021 Apr 22;384(16):1491-1502.
- NHS. University Hospitals Birmingham. COVID-19 tocilizumab & sarilumab treatment protocol. Nov. 29, 2021. https://www.uhb.nhs.uk/coronavirus-staff/clinical-info-pathways/clinical-info-pathways-downloads/c156-tocilizumab-treatment-protocol.pdf. (Accessed June 9, 2022).
- Product information for Olumiant. Lilly USA. Indianapolis, IN 46285. June 2022.
- FDA. Fact sheet for healthcare providers. Emergency Use Authorization (EUA) of baricitinib. May 2022. https://www.fda.gov/media/143823/download. (Accessed May 8, 2023).
- Guimarães PO, Quirk D, Furtado RH, et al. Tofacitinib in Patients Hospitalized with Covid-19 Pneumonia. N Engl J Med. 2021 Jul 29;385(5):406-415.
- FDA. Fact sheet for healthcare providers: Emergency Use Authorization for Lagevrio (molnupiravir) capsules. February 23, 2023. https://www.fda.gov/media/155054/download. (Accessed May 9, 2023).
- FDA. Center for Drug Evaluation and Research. FDA briefing document. Antimicrobial Drugs Advisory Committee meeting. November 30, 2021. https://www.fda.gov/media/154418/download. (Accessed May 9, 2023).
- Product information for Paxlovid. Pfizer. New York, NY 10017. May 2023.
- Emergency Use Authorization (EUA) for Paxlovid (nirmatrelvir tablets co-packaged with ritonavir tablets). Center for Drug Evaluation and Research (CDER) review. May 25, 2023. https://www.fda.gov/media/155049/download. (Accessed May 9, 2023).
- Product monograph for Paxlovid. Pfizer Canada. Kirkland, QC H9J 2M5. December 2022.
- Cleveland Clinic. Dysgeusia. Last reviewed November 4, 2021. https://my.clevelandclinic.org/health/diseases/22047-dysgeusia. (Accessed May 9, 2023).
- Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med. 2020 Nov 5;383(19):1813-1826.
- Goldman JD, Lye DCB, Hui DS, et al. Remdesivir for 5 or 10 Days in Patients with Severe Covid-19. N Engl J Med. 2020 Nov 5;383(19):1827-1837.
- Spinner CD, Gottlieb RL, Criner GJ, et al. Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients With Moderate COVID-19: A Randomized Clinical Trial. JAMA. 2020 Sep 15;324(11):1048-1057.
- Product information for Veklury. Gilead Sciences. Foster City, CA 94404. April 2023.
- Product monograph for Veklury. Gilead Sciences Canada. Mississauga, ON L5N 2W3. April 2022.
- Umemura T, Mutoh Y, Mizuno T, et al. Safety Evaluation of Remdesivir for COVID-19 Patients with eGFR < 30 mL/min without Renal Replacement Therapy in a Japanese Single-Center Study. Healthcare (Basel). 2022 Nov 17;10(11):2299.
- Pettit NN, Pisano J, Nguyen CT, et al. Remdesivir Use in the Setting of Severe Renal Impairment: A Theoretical Concern or Real Risk? Clin Infect Dis. 2021 Dec 6;73(11):e3990-e3995.
- FDA. Fact sheet for healthcare providers: Emergency Use Authorization for Kineret. November 2022. https://www.fda.gov/media/163075/download. (Accessed May 10, 2023).
- Tardif JC, Bouabdallaoui N, L'Allier PL, et al. Colchicine for community-treated patients with COVID-19 (COLCORONA): a phase 3, randomised, double-blinded, adaptive, placebo-controlled, multicentre trial. Lancet Respir Med. 2021 Aug;9(8):924-932.
- FDA. Fact sheet for health care providers. Emergency use authorization (EUA) of COVID-19 convalescent plasma for treatment of COVID-19. December 28, 2021. https://www.fda.gov/media/141478/download. (Accessed May 10, 2023).
- Ezer N, Belga S, Daneman N, et al. Inhaled and intranasal ciclesonide for the treatment of covid-19 in adult outpatients: CONTAIN phase II randomised controlled trial. BMJ. 2021 Nov 2;375:e068060.
- Clemency BM, Varughese R, Gonzalez-Rojas Y, et al. Efficacy of Inhaled Ciclesonide for Outpatient Treatment of Adolescents and Adults With Symptomatic COVID-19: A Randomized Clinical Trial. JAMA Intern Med. 2022 Jan 1;182(1):42-49.
- Anon. RECOVERY trial closes recruitment to colchicine treatment for patients hospitalised with COVIID-19. March 5, 2021. https://www.recoverytrial.net/news/recovery-trial-closes-recruitment-to-colchicine-treatment-for-patients-hospitalised-with-covid-19. (Accessed May 10, 2023).
- Brennan CM, Nadella S, Zhao X, et al. Oral famotidine versus placebo in non-hospitalised patients with COVID-19: a randomised, double-blind, data-intense, phase 2 clinical trial. Gut. 2022 May;71(5):879-888.
- Pahwani S, Kumar M, Aperna F, et al. Efficacy of Oral Famotidine in Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2. Cureus. 2022 Feb 20;14(2):e22404.
- Freedberg DE, Conigliaro J, Wang TC, et al. Famotidine Use Is Associated With Improved Clinical Outcomes in Hospitalized COVID-19 Patients: A Propensity Score Matched Retrospective Cohort Study. Gastroenterology. 2020 Sep;159(3):1129-1131.
- Yeramaneni S, Doshi P, Sands K, et al. Famotidine Use Is Not Associated With 30-day Mortality: A Coarsened Exact Match Study in 7158 Hospitalized Patients With Coronavirus Disease 2019 From a Large Healthcare System. Gastroenterology. 2021 Feb;160(3):919-921.
- FDA. Memorandum explaining basis for declining request for emergency use authorization of fluvoxamine maleate. May 6, 2022. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2020/EUA%20110%20Fluvoxamine%20Decisional%20Memo_Redacted.pdf. (Accessed May 10, 2023).
- Reis G, Dos Santos Moreira-Silva EA, Silva DCM, et al. Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with COVID-19: the TOGETHER randomised, platform clinical trial. Lancet Glob Health. 2022 Jan;10(1):e42-e51.
- FDA. Frequently asked questions on the revocation of the Emergency Use Authorization for hydroxychloroquine sulfate and chloroquine phosphate. June 19, 2020. https://www.fda.gov/media/138946/download. (Accessed May 10, 2023).
- Gautret P, Lagier JC, Parola P, et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents. 2020 Jul;56(1):105949.
- Press release. AMA, APhA, ASHP statement on ending use of ivermectin to treat COVID-19. September 1, 2021. https://www.ama-assn.org/press-center/press-releases/ama-apha-ashp-statement-ending-use-ivermectin-treat-covid-19. (Accessed May 10, 2023).
- Hill A, Garratt A, Levi J, et al. Meta-analysis of Randomized Trials of Ivermectin to Treat SARS-CoV-2 Infection. Open Forum Infect Dis. 2021 Jul 6;8(11):ofab358. doi: 10.1093/ofid/ofab358. Retraction in: Open Forum Infect Dis. 2022 Feb 05;9(3):ofac056.
- Roman YM, Burela PA, Pasupuleti V, et al. Ivermectin for the Treatment of Coronavirus Disease 2019: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Clin Infect Dis. 2022 Mar 23;74(6):1022-1029.
- FDA. Why you should not use ivermectin to treat or prevent COVID-19. December 10, 2021. https://www.fda.gov/consumers/consumer-updates/why-you-should-not-use-ivermectin-treat-or-prevent-covid-19. (Accessed June 7, 2022).
- Bramante CT, Huling JD, Tignanelli CJ, et al. Randomized Trial of Metformin, Ivermectin, and Fluvoxamine for Covid-19. N Engl J Med. 2022 Aug 18;387(7):599-610.
- Reis G, Dos Santos Moreira Silva EA, Medeiros Silva DC, et al. Effect of early treatment with metformin on risk of emergency care and hospitalization among patients with COVID-19: The TOGETHER randomized platform clinical trial. Lancet Reg Health Am. 2022 Feb;6:100142.
- Vlaar APJ, Witzenrath M, van Paassen P, et al. Anti-C5a antibody (vilobelimab) therapy for critically ill, invasively mechanically ventilated patients with COVID-19 (PANAMO): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Respir Med. 2022 Dec;10(12):1137-1146.
- FDA. Fact sheet for healthcare providers: Emergency Use Authorization for Gohibic. April 2023. https://www.fda.gov/media/166824/download. (Accessed May 10, 2023).
- RECOVERY Collaborative Group. Baricitinib in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial and updated meta-analysis. Lancet. 2022 Jul 30;400(10349):359-368. Erratum in: Lancet. 2022 Oct 1;400(10358):1102.
- Marconi VC, Ramanan AV, de Bono S, et al. Efficacy and safety of baricitinib for the treatment of hospitalised adults with COVID-19 (COV-BARRIER): a randomised, double-blind, parallel-group, placebo-controlled phase 3 trial. Lancet Respir Med. 2021 Dec;9(12):1407-1418. Erratum in: Lancet Respir Med. 2021 Oct;9(10):e102.
Cite this document as follows: Clinical Resource, Treatments of Interest for COVID-19. Pharmacist’s Letter/Pharmacy Technician’s Letter. June 2023. [390619]