Table 3.
Overview of drugs and recommendations for COVID-19 CAR-T recipients
| Drugs | Key issues to consider | Strength of recommendation |
|---|---|---|
| Antiviral drugs | The duration and course of antiviral treatment can be appropriately prolonged. | |
|
Nirmatrelvir and ritonavir (Paxlovid) (Target: 3CL) |
It is essential to monitor for drug-drug interactions, and the dosage should be modified in accordance with renal function. The COVID-19 drug interactions query website is https://covid19-druginteractions.org/checker. | Strong |
|
Remdesivir* (Target: RdRp) |
Remdesivir should not be taken if ALT > 10 ×ULN or if ALT levels are increased and there are symptoms of active hepatitis. | Weak or conditional |
|
Molnupiravir (Target: RdRp) |
No dose adjustment is required for renal or hepatic impairment. | Weak or conditional |
|
Azvudine (Target: RdRp) |
It is not recommended to use during pregnancy or lactation. Patients with moderately to severely impaired liver and kidney function should use it with caution. | Weak or conditional |
| Monoclonal antibodies | Patients with major risk factors for disease progression, high viral loads, and rapid disease development (depending upon predominant circulating viral variants). | |
| Bebtelovimab* | It is effective against all Omicron subvariant virus strains (including BA.1, BA.1.1, and BA.2). | Weak or conditional |
| Tixagevimab/cilgavimab* | It is only recommended for preexposure prophylaxis. | Weak or conditional |
| Convalescent plasma | The patient’s individual condition and viral load should be considered while determining whether to administer again. | Weak or conditional |
|
Human COVID-19 immunoglobulin |
Patients with major risk factors for disease progression, high viral loads, and rapid disease development. According to the patient’s condition, it can be infused once again the next day; the total number of infusions should be no more than 5. | Weak or conditional |
| Immunoregulatory drugs | ||
| Corticosteroids | Patients with critical and severe conditions that display rapid imaging progression, a body inflammatory response that is aggressive, and a steadily declining oxygenation index. The early use of systemic corticosteroids for severe and critical patients is emphasized. Patients with severe CRS could benefit from high-dose corticosteroid therapy. | |
| Dexamethasone | The dosage of dexamethasone should be adjusted to the severity of CRS. The dosage can be appropriately increased to 10 mg/6 h for 1–3 days in patients with ICANS. | Strong |
| Methylprednisolone | If ICANS symptoms are still not relieved following the use of dexamethasone, methylprednisolone may be administered. The dosage of methylprednisolone is 1000 mg/day for 3 days, 250 mg × 2/day for 2 days, 125 mg × 2/day for 2 days, and 60 mg × 2/day for 2 days. | Strong |
| IL-6 inhibitors | ||
| Tocilizumab | If CRS is exacerbated, combination therapy with IL-6 inhibitor tocilizumab (8 mg/kg) is recommended. Tocilizumab should be used with caution in the case of ICANS. | Strong |
| JAK inhibitors | ||
| Baricitinib | Attention should be given to symptoms and warning indications of thromboembolic events, and coagulation indicators should be identified when necessary. | Strong |
| Ruxolitinib | Most clinical criteria, symptoms (such as respiratory distress or the need for oxygen), and other clinical indications are used to determine whether to begin the use of ruxolitinib. | Weak or conditional |
| IVIGs | It is recommended for hypogammaglobulinemia (IgG < 4 g/l). | Strong |
* Not yet authorized for listing in China
ALT, alanine aminotransferase; ULN: upper limit of normal value; CRS, cytokine release syndrome; ICANS, immune effector cell-associated neurotoxicity syndrome; IVIGs, intravenous immunoglobulins