What is the problem and what is known about it so far?
COVID-19 is caused by a virus called SARS-CoV-2. The virus first appeared in 2019 and spread COVID-19 disease throughout the world. Various treatments are available as options for outpatient care of COVID-19.
Why did the researchers do this particular study?
The Scientific Medical Policy Committee (SMPC) of the American College of Physicians (ACP) developed these living, rapid practice points to summarize the best available evidence on the treatment of adults with confirmed COVID-19 in an outpatient setting.
Who was studied?
The population includes all adult patients diagnosed with COVID-19 in the outpatient setting regardless of whether a person received SARS-CoV-2 vaccine to prevent them from getting the disease.
How was the study done?
The SMPC developed these practice points according to ACP's process for the rapid development of practice points and policy on disclosure of interests and management of conflicts of interest. These practice points are based on a living, rapid review by the ACP Center for Evidence Reviews at Cochrane Austria at the University for Continuing Education Krems.
What did the researchers find?
ACP suggests that physicians consider treatment options depending on the health of a patient and how long a patient has had symptoms of COVID-19. Treatments to be considered are molnupiravir, nirmatrelvir–ritonavir combination therapy, or remdesivir in patients with confirmed mild to moderate COVID-19 in the outpatient setting who are within 5 days (nirmatrelvir–ritonavir), 7 days (remdesivir), or 5 to 7 days (molnupiravir) of the onset of symptoms and at high risk for progressing to severe disease. Physicians should not use azithromycin, chloroquine, hydroxychloroquine, ivermectin, nitazoxanide, lopinavir–ritonavir, casirivimab–imdevimab, regdanvimab, sotrovimab, convalescent plasma, ciclesonide, or fluvoxamine to treat patients with confirmed mild to moderate COVID-19 in the outpatient setting.
What were the limitations of the study?
The SARS-CoV-2 virus is changing continuously, and a new type can form known as a “variant.” COVID-19 has had many variants. The evidence informing these practice points was generated before the Omicron variant became the dominant circulating variant. Physicians should talk to their patients when making a decision about which treatment option to use. We do not know at this point if one treatment is better than another. Patients should talk to their physician about which medicines they are taking, including supplements such as vitamins. There are potential drug interactions to consider before starting a treatment against COVID-19. Remdesivir requires intravenous infusion. A patient who has tested negative for COVID-19 can test positive again, and this is known as rebound COVID-19. Rebound COVID-19 has been reported to occur with the use of nirmatrelvir–ritonavir between 2 and 8 days after initial recovery.
What are the implications of the study?
Three treatments are options for outpatients with mild to moderate COVID-19. The SMPC will update the practice points as more evidence becomes available.
Footnotes
This article was published at Annals.org on 29 November 2022.