CDC Treatment Guidelines
Dr. Ostrosky-Zeichner then discussed the National Institutes of Health (NIH) COVID-19 treatment guidelines for the management of non-hospitalized patients. “The cornerstone of management of this initial stage is the use of monoclonal antibodies,” he explained, adding that “there’s no evidence that starting corticosteroids in outpatients as a primary therapy is beneficial.”
He presented data from his institution’s COVID-19 monoclonal antibody program, saying that monoclonal antibodies are “a very effective and cost-effective intervention.” He noted that rheumatology patients who test positive for COVID-19 would benefit from early use of monoclonal antibodies, and he encouraged the use of monoclonal antibody therapy as prophylaxis in rheumatology patients if someone in the patient’s family has tested positive for COVID-19.
Editor’s note: On Dec. 8, the FDA authorized long-acting monoclonal antibodies (i.e., AstraZeneca’s Evusheld [tixagevimab co-packaged with cilgavimab and administered together]) for the pre-exposure prophylaxis (prevention) of COVID-19 in certain adults and pediatric individuals (12 years of age and older weighing at least 40 kgs [about 88 lbs]). The product is authorized only for those individuals who are not currently infected with the SARS-CoV-2 virus and who have not recently been exposed to an individual infected with SARS-CoV-2. The authorization also requires that individuals either have: moderate to severely compromised immune systems due to a medical condition or due to taking immunosuppressive medications or treatments and may not mount an adequate immune response to COVID-19 vaccination (examples of such medical conditions or treatments can be found in the fact sheet for healthcare providers) or; a history of severe adverse reactions to a COVID-19 vaccine and/or component(s) of those vaccines; therefore vaccination with an available COVID-19 vaccine, according to the approved or authorized schedule, is not recommended.
What not to do: “We do not recommend giving vitamins or supplements,” Dr. Ostrosky-Zeichner said. He also pointed to the NIH COVID-19 treatment guidelines, which state that there are insufficient data for the COVID-19 guidelines panel to recommend either for or against the use of ivermectin for the treatment of COVID-19. In addition, Dr. Ostrosky-Zeichner noted that “there is not enough evidence to suggest that convalescent plasma is beneficial for patients.”
Dr. Ostrosky-Zeichner also reviewed the NIH COVID-19 treatment guidelines for the management of hospitalized patients. “There are some patients who will benefit from remdesivir, which is the only antiviral approved for COVID-19 right now,” he said. These include patients who are hospitalized and require supplemental oxygen.
