New information on the clinical spectrum of SARS-CoV-2 infections, use of ritonavir-boosted nirmatrelvir in pregnant patients, and use of ivermectin in patients with mild-to-moderate COVID-19 is included in updated COVID-19 Treatment Guidelines released yesterday by an NIH advisory panel.
Breakthrough infections and viral or symptom rebound are among the topics covered in a discussion of the clinical spectrum of SARS-Co-2 infections. The spectrum includes illnesses that are asymptomatic or presymptomatic, mild, moderate, severe, or critical. In addition, prolonged viral shedding with or without symptoms can occur in patients who are immunocompromised and have COVID-19, the panel said.
Information from 2 case series of patients with pregnancy who received ritonavir-boosted nirmatrelvir is included to support the panel’s advice to consider use in “pregnant and recently pregnant patients with COVID-19 who qualify for this therapy based on the results of a risk-benefit assessment.” The panel wrote, “Forty-seven patients were included in 1 case series, and 7 patients were included in the other. The treatment was well tolerated in both these case series, and no serious adverse effects were reported in either the pregnant patients or the neonates.”
Information from 3 large randomized controlled trials is added to the guidelines to support a recommendation against the use of ivermectin for the treatment of COVID-19. The study populations in these and most other reviewed trials were “patients with mild-to-moderate COVID-19 who had a relatively low risk for disease progression, and the number of deaths was low (as expected),” the panel wrote. “In these randomized trials, completely excluding an effect of ivermectin on COVID-19 disease progression is difficult because the trials were not powered to detect differences in secondary outcomes, such as death. However, data from these trials do not provide evidence that the use of ivermectin is effective for the treatment of COVID-19.”
Other minor updates cover drug–drug interactions between ritonavir-boosted nirmatrelvir and concomitant medications, convalescent plasma, antiviral and antibody products, interleukin-6 inhibitors, and zinc.