NIH Releases New Version of COVID-19 Treatment Guidelines

April 21, 2023

The COVID-19 Treatment Guidelines Panel (the Panel) has published a major update to the Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. Major changes include:

• Pregnancy, Lactation, and COVID-19 Therapeutics. This new section has been added to provide guidance on the use of Panel-recommended therapies in pregnant or lactating patients with COVID-19.
• Therapeutic Management of Nonhospitalized Adults With COVID-19. The Panel clarified the goals of therapeutic management for nonhospitalized patients and discussed the limitations of the data that inform the Panel's recommendations. Data from the PANORAMIC trial have been added to the rationale for molnupiravir and the Panel expanded the subsection on viral rebound and symptom recurrence.
• Therapeutic Management of Hospitalized Adults With COVID-19. The Panel recommends using dexamethasone as the primary immunomodulator for all patients who require high-flow nasal canula oxygen, noninvasive ventilation, mechanical ventilation, or extracorporeal membrane oxygenation. A second immunomodulator (e.g., baricitinib, tocilizumab) should be added to dexamethasone for the treatment of these patients.
• Oxygenation and Ventilation for Adults. The Panel updated the rationale for its recommendations with information from recent studies. In addition, the recommendations and rationale for using neuromuscular blocking agents in mechanically ventilated adults with moderate to severe acute respiratory distress syndrome were streamlined, and one of the recommendations was removed.
• Molnupiravir. This section now includes information from the PANORAMIC trial (see above), an open-label randomized controlled trial that enrolled nonhospitalized adults with COVID-19.
• Interferons. The Panel summarized the data from the TOGETHER trial on the use of pegylated interferon lambda in nonhospitalized patients with COVID-19. However, because interferon lambda is not available in the United States, the Panel is not able to make a recommendation for or against the use of this agent.
• Janus Kinase Inhibitors. Information on kinase inhibitors that are not recommended for the treatment of COVID-19, including the Janus kinase inhibitor ruxolitinib and Bruton’s tyrosine kinase inhibitors, has been removed.
• Interleukin-6 Inhibitors. This section now includes updated 180-day data from the REMAP-CAP trial. Information on agents that are not recommended for the treatment of COVID-19 has been removed from the section.

For a full list of updates, please see What's New in the Guidelines on the COVID-19 Treatment Guidelines website.