Immunomodulators Under Evaluation for the Treatment of COVID-19

See Therapeutic Management of Patients with COVID-19 for the COVID-19 Treatment Guidelines Panel’s (the Panel’s) recommendations on the use of the following:

• Dexamethasone (or other corticosteroids) with or without remdesivir
• Baricitinib with remdesivir.

See additional recommendations on the use of baricitinib below.

See Statement on the Use of Tocilizumab (and Other Interleukin-6 Inhibitors) for the Panel’s recommendations on the use of tocilizumab and sarilumab.

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:

• Baricitinib in combination with corticosteroids. Because both agents are potent immunosuppressants, there is potential for an additive risk of infection.
• Baricitinib in combination with remdesivir for hospitalized COVID-19 patients when corticosteroids can be used
• Interleukin (IL)-1 inhibitors (e.g., anakinra)
• Interferon beta for the treatment of early (i.e., <7 days from symptom onset) mild to moderate COVID-19

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

• Siltuximab, an anti-IL-6 monoclonal antibody (AIII)
• Baricitinib without remdesivir (AIII)
• Interferons (alfa or beta) for the treatment of severely or critically ill patients with COVID-19 (AIII)
• Kinase inhibitors:
  • Bruton’s tyrosine kinase inhibitors (e.g., acalabrutinib, ibrutinib, zanubrutinib) (AIII)
  • Janus kinase inhibitors other than baricitinib (e.g., ruxolitinib, tofacitinib) (AIII)
• Non-SARS-CoV-2-specific intravenous immune globulin (IVIG) (AIII). This recommendation should not preclude the use of IVIG when it is otherwise indicated for the treatment of complications that arise during the course of COVID-19.