What's New in the Guidelines
Last Updated: March 6, 2023
The Coronavirus Disease 2019 (COVID-19) Treatment Guidelines is published in an electronic format that can be updated in step with the rapid pace and growing volume of information regarding the treatment of COVID-19.
The COVID-19 Treatment Guidelines Panel (the Panel) is committed to updating this document to ensure that health care providers, patients, and policy experts have the most recent information regarding the optimal management of COVID-19 (see the Panel Roster for a list of Panel members).
New Guidelines sections and recommendations and updates to existing Guidelines sections are developed by working groups of Panel members. All recommendations included in the Guidelines are endorsed by a majority of Panel members (see Guidelines Development for additional details on the development process).
Major revisions to the Guidelines within the past month are as follows:
March 6, 2023
Updates Regarding the Use of Tixagevimab Plus Cilgavimab
In the United States, the prevalence of SARS-CoV-2 Omicron subvariants that are not susceptible to tixagevimab plus cilgavimab (Evusheld) is now more than 90%. Because of this, tixagevimab plus cilgavimab is not authorized for use as COVID-19 pre-exposure prophylaxis (PrEP) in the United States. The Panel now recommends against the use of tixagevimab plus cilgavimab as COVID-19 PrEP (AIII).
In this update, several sections of the Guidelines have been revised to reflect this recommendation. These sections include:
- Overview of COVID-19
- Testing for SARS-CoV-2 Infection
- Prevention of SARS-CoV-2 Infection
- Anti-SARS-CoV-2 Monoclonal Antibodies
- Special Considerations in People Who Are Immunocompromised
- Special Considerations in Adults and Children With Cancer
- Special Considerations in Solid Organ Transplant, Hematopoietic Cell Transplant, and Cellular Immunotherapy Candidates, Donors, and Recipients
- Special Considerations During Pregnancy and After Delivery
- Special Considerations in People With HIV
Clinical Spectrum of SARS-CoV-2 Infection
The Panel updated the information on breakthrough infection in this section. This section also includes an expanded description of viral or symptom rebound after COVID-19 and prolonged viral shedding with or without symptoms in patients who are immunocompromised and who have COVID-19.
Ritonavir-Boosted Nirmatrelvir (Paxlovid)
This section has been updated with information from 2 case series that describe clinical experience with ritonavir-boosted nirmatrelvir in pregnant patients with COVID-19. Forty-seven patients were included in 1 case series, and 7 patients were included in the other. The treatment was well tolerated in both these case series, and no serious adverse effects were reported in either the pregnant patients or the neonates. The Panel continues to note that ritonavir-boosted nirmatrelvir should be offered to pregnant and recently pregnant patients with COVID-19 who qualify for this therapy based on the results of a risk-benefit assessment.
Three large randomized controlled trials that were published after the last Guidelines update have reported that the use of ivermectin did not provide a clinical benefit for patients with mild to moderate COVID-19. Based on the results from these 3 trials and other studies previously reviewed by the Panel, the Panel recommends against the use of ivermectin for the treatment of COVID-19 (AIIa). Table 7d was updated to include the results from key clinical trials that have been published since the last revision.
Minor updates were made to the following sections: