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Immunomodulators Under Evaluation for the Treatment of COVID-19

Last Updated: August 27, 2020

Summary Recommendations
Summary Recommendations

Dexamethasone

  • On the basis of the preliminary report from the Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial, the COVID-19 Treatment Guidelines Panel (the Panel) recommends using dexamethasone 6 mg per day for up to 10 days or until hospital discharge, whichever comes first, for the treatment of COVID-19 in hospitalized patients who are mechanically ventilated (AI) and in hospitalized patients who require supplemental oxygen but who are not mechanically ventilated (BI).
  • The Panel recommends against using dexamethasone for the treatment of COVID-19 in patients who do not require supplemental oxygen (AI).
  • If dexamethasone is not available, the Panel recommends using alternative glucocorticoids such as prednisone, methylprednisolone, or hydrocortisone (see Additional Considerations in the Corticosteroids section for dosing recommendations) (AIII).

Other Immunomodulators

There are insufficient data for the Panel to recommend either for or against the use of the following immunomodulators for the treatment of COVID-19:

  • Interleukin (IL)-1 inhibitors (e.g., anakinra)
  • Interferon beta for the treatment of early (i.e., <7 days from symptom onset) mild and moderate COVID-19.

The Panel recommends against the use of the following immunomodulators for the treatment of COVID-19, except in a clinical trial:

  • Anti-IL-6 receptor monoclonal antibodies (e.g., sarilumab, tocilizumab) or anti-IL-6 monoclonal antibody (siltuximab) (BI).
  • Interferons (alfa or beta) for the treatment of severely or critically ill patients with COVID-19 (AIII).
  • Bruton’s tyrosine kinase inhibitors (e.g., acalabrutinib, ibrutinib, zanubrutinib) and Janus kinase inhibitors (e.g., baricitinib, ruxolitinib, tofacitinib) (AIII).
Rating of Recommendations: A = Strong; B = Moderate; C = Optional
Rating of Evidence: I = One or more randomized trials with clinical outcomes and/or validated laboratory endpoints; II = One or more well-designed, nonrandomized trials or observational cohort studies; III = Expert opinion