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Immunomodulators Under Evaluation for the Treatment of COVID-19

Last Updated: October 19, 2021

Summary Recommendations
Summary Recommendations

The hyperactive inflammatory response to SARS-CoV-2 infection plays a central role in the pathogenesis of COVID-19. See Therapeutic Management of Hospitalized Adults with COVID-19 for the COVID-19 Treatment Guidelines Panel’s (the Panel) recommendations on the use of the following immunomodulators for hospitalized patients according to their disease severity:

  • Corticosteroids: Dexamethasone
  • Interleukin (IL-6) inhibitors: Tocilizumab (or sarilumab)
  • Janus kinase (JAK) inhibitors: Baricitinib (or tofacitinib)

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

  • Anakinra
  • Colchicine for nonhospitalized patients
  • Fluvoxamine
  • Granulocyte-macrophage colony-stimulating factor inhibitors for hospitalized patients
  • Inhaled budesonide
  • 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:

  • Baricitinib plus tocilizumab (AIII)
  • Canakinumab (BIIa)
  • Colchicine for hospitalized patients (AI)
  • Interferons (alfa or beta) for the treatment of severely or critically ill patients with COVID-19 (AIII)
  • Intravenous immunoglobulin (IVIG) (non-SARS-CoV-2-specific) for the treatment of patients with acute COVID-19 (AIII). This recommendation should not preclude the use of IVIG for multisystem inflammatory syndrome in children (MIS-C) or when it is otherwise indicated.
  • Bruton’s tyrosine kinase inhibitors (e.g., acalabrutinib, ibrutinib, zanubrutinib) (AIII)
  • JAK inhibitors other than baricitinib and tofacitinib (e.g., ruxolitinib) (AIII)
  • Siltuximab (BIII)
Rating of Recommendations: A = Strong; B = Moderate; C = Optional
Rating of Evidence: I = One or more randomized trials without major limitations; IIa = Other randomized trials or subgroup analyses of randomized trials; IIb = Nonrandomized trials or observational cohort studies; III = Expert opinion