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Immunomodulators

Last Updated: December 1, 2022

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 and Therapeutic Management of Hospitalized Children 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-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
  • Granulocyte-macrophage colony-stimulating factor inhibitors in hospitalized patients
  • Inhaled corticosteroids

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

  • Canakinumab (BIIa)
  • Bruton’s tyrosine kinase inhibitors (e.g., acalabrutinib, ibrutinib, zanubrutinib) (AIII)
  • JAK inhibitors other than baricitinib and tofacitinib (e.g., ruxolitinib) (AIII)
  • Siltuximab (BIII)
Each recommendation in the Guidelines receives 2 ratings that reflect the strength of the recommendation and the quality of the evidence that supports it. See Guidelines Development for more information.