TABLE 1.

Immunomodulatory therapies recommended by the Infectious Diseases Society of America (IDSA) and/or FDA for COVID-19 treatment.

Therapeutic	Adult patient population	Dosing	Potential adverse reactions	Certainty of recommendation
Glucocorticoids (Dexamethasone preferred)	Hospitalized and/or severe COVID-19 disease.	Dexamethasone 6 mg IV or PO × 10 days or until discharge.	Hyperglycemia, neurological side effects (agitation/confusion), adrenal suppression, risk of bacterial or fungal infection	Moderate
Tocilizumab	Hospitalized with severe COVID-19 disease, elevated inflammatory markers, requiring supplemental oxygen, NIMV, IMV, or ECMO.	Weight < 30 kg: 12 mg/kg IV over 60 min. Weight > 30 kg: 8 mg/kg IV over 60 min. (Maximum dose 800 mg)	Increased risk of infection, gastrointestinal perforation (seen in non-COVID settings)	Low
Sarilumab	Hospitalized who meet criteria for tocilizumab, but it is not available.	400 mg IV over 60 min.	Increased risk of infection	Very Low
Baricitinib	Hospitalized with severe COVID-19 disease and elevated inflammatory markers, requiring supplemental oxygen, NIMV, IMV, or ECMO. Also indicated for use with remdesivir when corticosteroid contraindicated.	Baricitinib 4 mg PO daily × 14 days or until discharge.	Increased risk of infection, bowel perforation, thromboembolism, ischemic colitis, elevated transaminases, seizure	Moderate
Convalescent plasma (high-titer antibody)	Outpatient or hospitalized, with immunosuppressive disease or receiving immunosuppressive treatment, early in disease course.	NA	Circulatory overload, transfusion-associated lung injury, allergic transfusion reaction, thromboembolism	Low

Certainty of Recommendation Grades (based on data from clinical trials, and the risk of bias, inconsistency, indirectness, imprecision, and publication bias noted in the studies):

High: Based on data from clinical trials, the true effect lies close to that of the estimate of the effect.

Moderate: Based on data from clinical trials, the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.

Low Certainty: Based on data from clinical trials, the true effect may be substantially different form the estimate of the effect.

Very Low Certainty: Based on data from clinical trials, the true effect is likely to be substantially different from the estimate of the effect.

IV, intravenous; PO, oral; NIMV, non-invasive mechanical ventilation; IMV, invasive mechanical ventilation; ECMO, extracorporeal membrane oxygenation; NA, not applicable.