IDSA updates treatment guidance for COVID-19, including monoclonal antibodies
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The Infectious Diseases Society of America has updated its treatment guidelines for COVID-19 for several therapies, including tocilizumab, ivermectin and bamlanivimab with etesevimab.
After an assessment of eight randomized trials, the guideline panel now recommends that tocilizumab should be used in hospitalized patients who are sick enough to have progressive, severe or critical COVID-19. Results from the RECOVERY trial suggest that tocilizumab reduces the risk for death in seriously ill patients with COVID-19.
The guideline panel suggests against the use of ivermectin outside of clinical trials for both hospitalized patients and outpatients, and advocates for the use of bamlanivimab and etesevimab together in outpatients with mild to moderate disease who are at high risk for progression to severe disease.
At an IDSA press briefing, Rajesh T. Gandhi, MD, a member of the IDSA’s expert panel on COVID-19 treatment and management guidelines and an infectious diseases physician at Massachusetts General Hospital, said that it is possible bamlanivimab by itself or casirivimab and imdevimab may have a similar clinical benefit, but that data are currently limited. He also discussed the importance of the timing of bamlanivimab therapy.
“By the time patients are sick enough to be in the hospital, the window of opportunity may have closed for bamlanivimab,” Gandhi said.
During the briefing, Adarsh Bhimraj, MD, FIDSA, section head of neurologic infectious diseases at Cleveland Clinic and first author of the IDSA’s COVID-19 management and treatment guidelines, said it is important to continue updating the guidelines because of the “overwhelming avalanche” of COVID-19 research with “varying quality of evidence,” as well as misinformation. He also stressed the importance of continued mitigation efforts as the vaccine rollout continues.
“We should continue to do what we are doing — masking, social distancing, continuing surveillance and research — as it impacts not just this pandemic but also future pandemics and epidemics,” he said.
Gandhi said that better preparation is needed to ensure treatments can be effectively developed in the event of another pandemic.
“We need a strong public health and clinical research structure going into pandemics rather than trying to build them during a pandemic,” Gandhi said.
Gandhi also stressed the importance of equitable access to COVID-19 treatments.
“These treatments can’t be so siloed that people don’t have access to them,” he said.
References:
- IDSA. IDSA guidelines on the treatment and management of patients with COVID-19. https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/. Accessed March 18, 2021.
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