• Recent trials assessing ICS in symptomatic COVID-19 have found conflicting results.
• The phase II STOIC trial assessing budesonide 800 mcg BID (n=73) until symptom resolution found a reduction in COVID-19 related urgent care, ED visits, or hospitalizations compared to usual care. 
• The phase III COVERAGE trial assessing ciclesonide 320 mcg BID x 10 days (n=110) found no benefit in reducing risk of progression compared to usual care.
• See outpatient guideline on COVID microsite for more literature analysis. 
• Due to cost and uncertainty regarding the benefits of ICS relative to the documented benefits of alternative options such as Paxlovid, the Covid Medical Advisory committee recommends against the routine use of ICS, particularly when other options are available and appropriate.

• In a sub-group analyses of the RECOVERY trial, there was no evidence for benefit and a trend toward harm when dexamethasone was given to hospitalized patients without hypoxia not receiving supplemental oxygen.
•  The NIH and IDSA do not recommend use of corticosteroids in this population at this time. Steroids can lead to adverse effects, such as hyperglycemia, neuropsychiatric symptoms, and secondary infections, all of which may be difficult to detect and monitor in an outpatient setting.

Limited evidence of effectiveness of hydroxychloroquine in treatment of Covid-19 patients, and a recent study showed an association of increased overall mortality was identified in patients treated with hydroxychloroquine alone, highlighting importance of waiting for results of prospective, randomized, controlled studies before widespread use.

• Two recent RCTs assessing IVM 400 mcg/kg for 3 - 5 days vs. usual care in patients with mild-moderate infection (within 7 days of symptom onset) and at least one risk for disease progression failed to show a significant benefit of Ivermectin in preventing progression of disease requiring O2 or to hospitalization. 
• See COVID microsite for review of current literature