Treatment Options Overview

Baricitinib is a Janus-associated kinase (JAK) inhibitor that reduces mortality and may reduce progression to mechanical ventilation. By inhibiting JAK, the inflammatory and immunopathology response from COVID may be reduced. Unique to baricitinib is the theoretical ability to directly interfere with viral uptake into cells.

Interleukin (IL)-6 is a proinflammatory cytokine response which is induced by COVID. Tocilizumab is an IL-6 inhibitor, which helps reduce the systemic inflammation and hypoxemic respiratory failure associated with COVID.

Remdesivir and Nirmatrelvir are both antiviral agents that block viral replication.

Ritonavir is a protease inhibitor which blocks the metabolism of Nirmatrelvir, resulting in increased serum concentration of Nirmatrelvir. Ritonavir has no direct activity against COVID.

Treatment Guidelines

Disclaimer: The treatment guidelines provided within this app may differ slightly from the Ontario Science Table COVID-19 Clinical Practice Guideline due to ongoing drug shortages. There may appear to be further restrictions and treatment criteria than those posted on the Ontario Science Table guideline which have been agreed upon in discussions within the provincial hospital pharmacy group to best align with equitable distribution of medications.

More Information

  1. Ontario COVID-19 Science Advisory Table - Clinical Practice Guideline Summary: Recommended Drugs and Biologics in Adult Patients with COVID-19 version 11.0. Available Here.
  2. Ontario COVID-19 Science Advisory Table - Evidence-Based Recommendations on the Use of Nirmatrelvir/Ritonavir (Paxlovid) for Adults in Ontario. Available Here.
  3. Ontario COVID-19 Science Advisory Table - Evidence-Based Recommendations on the Use of Anti-SARS-CoV-2 Monoclonal Antibodies (Casirivimab + Imdevimab, and Sotrovimab) for Adults in Ontario. Available Here.
  4. Public Health Ontario Coronavirus Disease 2019 (COVID-19) - Serology. Available Here.
  5. NIH COVID-19 Treatment Guidelines. Available Here.
  6. Baricitinib for Hospitalized Patients with COVID-19. Available Here.
  7. Ontario Pharmacists Association - Important update regarding Dispensing of Paxlovid (nirmatrelvir/ritonavir) in community pharmacist. Available here.
  8. Ontario Renal Network - COVID-19 Supplemental Clinical Guidance #4: Nirmatrelvir/Ritonavir (Paxlovid) Use in Patients With Advanced Chronic Kidney Disease and Patients on Dialysis with COVID-19.