Firstline - Clinical Decisions

Disclaimer

The Scientific Research Committee ensures timely review of emerging experimental therapies, therefore, off-label use of therapies with only published in vitro data should NOT be implemented until reviewed and sanctioned by this committee

The recommendations below are subject to change based on emerging data or drug shortage information

Therapies NOT Recommended

These medications have been reviewed, but due to lack of evidence, these medications are not currently recommended for the treatment of COVID-19

Azithromycin

Based on current evidence demonstrating lack of benefit in preventing invasive mechanical ventilation or death in hospitalized patients, use of azithromycin for treatment of COVID-19 is not recommended

Bamlanivimab/etesevimab and casirivimab/imdevimab

Due to the predominance of the Omicron variant in the US (>99% of COVID-19 cases as of 1/18/22), casirivimab/imdevimab and bamlanivimab/etesevimab are no longer authorized or recommended for the treatment or prophylaxis of COVID-19

Colchicine

Use of colchicine in non-hospitalized patients with COVID-19 is not recommended based on current evidence demonstrating no difference of a composite endpoint of death or hospitalization by Day 30 (COLCORONA Trial) nor the median time to self-reported recovery (PRINCIPLE trial) in the colchicine group versus the control group, nor in other clinically relevant outcomes
Use of colchicine in hospitalized patients with COVID-19 is not recommended

Hydroxychloroquine or chloroquine

Based on studies demonstrating harm and little clinical benefit, the use of hydroxychloroquine for the treatment of COVID-19 is NOT recommended outside of a clinical trial

Ivermectin

Current evidence for the benefit of ivermectin is weak and does not support the use of ivermectin for COVID-19
- In line with the NIH panel, the SRC does not find that the available data are sufficient to recommend the use of ivermectin to treat hospitalized patients with COVID-19
- This recommendation will be periodically re-evaluated if new randomized controlled trials become available.
International COVID -19 Guidelines & Statements on the Use of Ivermectin for the Treatment of COVID-19:

Lopinavir/ritonavir

Use of lopinavir/ritonavir is not recommended because of unfavorable pharmacodynamics and negative clinical trial data

Micronutrients (Vitamin C and Zinc)

Adjunctive use of micronutrients in COVID-19 patients beyond the recommended daily allowances for supplementation is not supported by scientific evidence
If utilization is necessary for the treatment of nutritional deficiencies, a once daily dosing strategy should be employed

Famotidine

Data fails to demonstrate beneficial effects of high-dose famotidine in ambulatory patients at day 28
Standard dose famotidine also failed to demonstrate benefits in mortality, ICU length of stay, or mechanical ventilation in hospitalized patients with severe COVID-19 infections

Inhaled Corticosteroids

Among ambulatory patients with mild-to-moderate COVID-19, inhaled corticosteroids did not demonstrate benefit on mortality or hospitalization