On May 12, 2020, the National Institutes of Health (NIH) issued updated treatment guidelines for COVID-19. The update includes the following key recommendations.
Antithrombotic Therapy in Patients with COVID-19
Patients with COVID-19 who experience an incident thromboembolic event or who are highly suspected to have thromboembolic disease at a time when imaging is not possible should be managed with therapeutic doses of anticoagulant therapy as per the standard of care for patients without COVID-19.
Patients with COVID-19 who require extracorporeal membrane oxygenation or continuous renal replacement therapy or who have thrombosis of catheters or extracorporeal filters should be treated with antithrombotic therapy per the standard institutional protocols for those without COVID-19.
On the basis of preliminary clinical trial data, the Panel recommends the investigational antiviral agent remdesivir for the treatment of COVID-19 in hospitalized patients with severe disease, defined as SpO2 ≤ 94% on ambient air (at sea level), requiring supplemental oxygen, mechanical ventilation, or extracorporeal membrane oxygenation.
Remdesivir is not approved by the Food and Drug Administration (FDA); however, it is available through an FDA emergency use authorization for the treatment of hospitalized adults and children with COVID-19. Remdesivir is also being investigated in clinical trials, and it is available through an emergency access program for children and pregnant patients.
The Panel does not recommend remdesivir for the treatment of mild or moderate COVID-19 outside the setting of a clinical trial.
The Panel recommends against using high-dose chloroquine (600 mg twice daily for 10 days) for the treatment of COVID-19, because the high dose carries a higher risk of toxicities than the lower dose. The FDA warning that cautioned against the use of chloroquine or hydroxychloroquine for COVID-19 outside the setting of a hospital or clinical trial was added to this section.
Convalescent Plasma and Immune Globulins
New information has been added to the section on convalescent plasma and SARS-CoV-2-specific immune globulins. A new section for non-SARS-CoV-2 intravenous immune globulin (IVIG) was created, in which the Panel recommends against the use of non-SARS-CoV-2-specific IVIG for the treatment of COVID-19, except in the context of a clinical trial. This should not preclude the use of IVIG when it is otherwise indicated for the treatment of complications that arise during the course of COVID-19.
National Institutes of Health (NIH). COVID-19 Treatment Guidelines: What’s New in the Guidelines. Last Updated: May 12, 2020. Available at: click here. Accessed May 13, 2020.