Table 1.

Summary of recommendations.

Agent	Clinical question	Recommendation(s)	Strength of recommendation and quality of evidence
I. Immunomodulation therapy
Corticosteroids	Should corticosteroids vs. no corticosteroids be used for severe or critical COVID-19?	1. For adults with severe or critical COVID-19 in the ICU, the panel recommends using systemic corticosteroids	Strong recommendation, high quality evidence.
		2. The panel suggests using dexamethasone 6 mg daily for 10 days over other corticosteroids	Weak recommendation, low quality evidence.
Tocilizumab	Should tocilizumab vs. no tocilizumab be used for severe or critical COVID-19?	3. For adults with COVID-19 who are receiving high-flow nasal cannula or noninvasive ventilation, the panel suggests using tocilizumab over not using it	Weak recommendation, low quality evidence.
		Remark:
		Studies shown benefit of tocilizumab when used concomitantly with corticosteroids in patients with elevated C-reactive protein (CRP) >75 mg/l, or when tocilizumab therapy was initiated within 24 h of ICU admission.
		4. Due to insufficient evidence, we were unable to issue a recommendation for or against the use of tocilizumab in invasively ventilated COVID-19 patients. If clinicians decide to use tocilizumab in this context, it is probably better to use it early (within 24 h of admission) and/or in patients with CRP level >75 mg/l.	No recommendation
Baricitinib	Should baricitinib and remdesivir vs. remdesivir alone be used for severe or critical COVID-19?	5. For adults with critical COVID-19; the panel suggests against the routine use of baricitinib in combination with remdesivir	Weak recommendation, low quality evidence.
		6. For selected cases with severe COVID-19 on NIV or HFNC who cannot receive corticosteroids or tocilizumab, we suggest using a combination of baricitinib and remdesivir over remdesivir alone	Weak recommendation, low quality evidence.
Convalescent plasma	Should convalescent plasma vs. no convalescent plasma be used for severe or critical COVID-19?	7. For adults with severe or critical COVID-19 in the ICU, the panel recommends against using convalescent plasma	Strong recommendation, moderate quality evidence.
Immunoglobulins	Should intravenous immunoglobulin (IVIG) vs. no IVIG be used for severe or critical COVID-19?	8. For adults with severe or critical COVID-19 in the ICU, the panel suggests against the routine use of IVIG outside the context of clinical trials	Weak recommendation, low quality evidence.
II. Antiviral therapy
Remdesivir	Should remdesivir vs. no remdesivir be used for critical COVID-19?	9. For mechanically ventilated adults with critical COVID-19, we suggest against using remdesivir outside the context of clinical trials	Weak recommendation, low quality evidence.
Favipiravir	Should favipiravir vs. no favipiravir be used for severe or critical COVID-19?	10. For adults with severe or critical COVID-19 in the ICU, the panel suggests against the routine use of favipiravir outside the context of clinical trials	Weak recommendation, very low quality evidence.
III. Hydroxychloroquine (HCQ)
HCQ	Should HCQ vs. no HCQ be used for severe or critical COVID-19?	11. For adults with severe or critical COVID-19 in the ICU, the panel recommends against using HCQ	Strong recommendation, moderate quality evidence.
VI. Anticoagulation
Therapeutic anticoagulation	Should therapeutic anticoagulation vs. prophylactic dose anticoagulation be used for critical COVID-19?	12. For adults with critical COVID-19 and no clinical suspicion of venous thromboembolism (VTE), we suggest using prophylactic dosing anticoagulation over therapeutic anticoagulation	Weak recommendation, low quality evidence.
		Remark:
		This recommendation does not apply to patients with high suspicion of acute VTE or those with other indications for therapeutic anticoagulation.