The American College of Physicians (ACP) updates its living, rapid practice points focusing on 22 outpatient treatments for COVID-19 and provides a literature review to support the new recommendations.
Four practice points are added pertaining specifically to the omicron variant of SARS-CoV-2:
Practice Point 1: Consider molnupiravir to treat symptomatic patients with confirmed mild-to-moderate COVID-19 in the outpatient setting who are within 5 days of the onset of symptoms and at a high risk for progressing to severe disease.
Practice Point 2: Consider nirmatrelvir–ritonavir combination therapy to treat symptomatic patients with confirmed mild-to-moderate COVID-19 in the outpatient setting who are within 5 days of the onset of symptoms and at a high risk for progressing to severe disease.
Practice Point 3: Do not use ivermectin to treat patients with confirmed mild-to-moderate COVID-19 in the outpatient setting.
Practice Point 4: Do not use sotrovimab to treat patients with confirmed mild-to-moderate COVID-19 in the outpatient setting.
Literature review: Evidence from 2 randomized controlled trials and 6 retrospective cohort studies provided evidence for the above points: “Nirmatrelvir–ritonavir was associated with a reduction in hospitalization due to COVID-19 (for example, 0.7% vs. 1.2%; moderate [certainty of evidence (COE)]) and all-cause mortality (for example, <0.1% vs. 0.2%; moderate COE). Molnupiravir led to a higher recovery rate (31.8% vs. 22.6%; moderate COE) and reduced time to recovery (9 vs. 15 median days; moderate COE) but had no effect on all-cause mortality (0.02% vs. 0.04%; moderate COE) and the incidence of serious adverse events (0.4% vs. 0.3%; moderate COE). Ivermectin had no effect on time to recovery (moderate COE) and resulted in no difference in adverse events compared with placebo (low COE). Sotrovimab resulted in no difference in all-cause mortality compared with no treatment (low COE). No eligible studies for all other treatments of interest were identified.”
