• The HFSA, ACC and AHA emphasize the lack of experimental or clinical data on these class of drugs in COVID-19 and recommend that patients currently taking these medications for known beneficial indications (HF, HTN, or ischemic heart disease, for example) be advised to continue
• They advise against adding/removing beyond what would be done in standard practice and urge individualized treatment decisions based on patient’s clinical presentation and hemodynamics

• Synthetic vasoactive intestinal peptide (VIP)
• Mechanism:
  • Binds to receptors on alveolar type II (ATII) cells in the lung
  • ATII cells bind SARS-CoV-2 via their angiotensin-converting enzyme 2 receptors
• VIP protects alveolar cells and the surrounding pulmonary epithelium by:
  • 1. Blocking cytokines
  • 2. Preventing apoptosis
  • 3. Upregulating surfactant production
• Animal models of respiratory distress: potent anti-inflammatory and anti-cytokine activity
• Clinical data are lacking to establish the potential benefits and risks associated with the use of aviptadil in patients with COVID-19
• There is insufficient evidence to recommend the use of aviptadil for treatment of critical COVID-19 outside of a clinical trial at this time
• Phase 2b/3 data
  • Aviptadil vs. placebo in patients treated with RDV or other approved/authorized therapies
  • Primary endpoint = Alive & free of respiratory failure at day 28
    • 2.8-fold increased odds of being alive and free of respiratory failure at day 28 (P=0.03)
    • 4-fold increased odds of surviving to 60 days (P=.006)
  • Patients on ventilators at time of randomization demonstrated 10-fold increased odds of survival (P=.03)
  • AEs = mild to moderate diarrhea, systemic hypotension
• For more information on the Right to Try program, refer to Aviptadil Right to Try - NRx Pharmaceuticals

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

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 recommended for the treatment of COVID-19

Based on the results of a randomized trial in hospitalized patients with COVID-19 (RECOVERY), colchicine demonstrated no benefit with regards to 28-day mortality or any secondary outcomes; use of colchicine in hospitalized patients is not recommended

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

Current evidence for the benefit of ivermectin is weak and the results of two high-quality randomized controlled trials showed no evidence of benefit, thus ivermectin should not be used for the treatment of 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:

• Merck Statement on Ivermectin use in COVID-19
• IDSA Guidelines for Treatment of COVID-19 - Ivermectin
• Statement on Ivermectin
  COVID-19 Treatment Guidelines

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

• 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

• There is no evidence for or against the management of fever with NSAIDs
• Acetaminophen is preferred for management of fever, but each clinical scenario should be carefully evaluated

• Nebulized respiratory medications should be avoided in non-intubated patients unless otherwise indicated in patients with bronchospasms to prevent the spread of the COVID-19
• For COVID-19 negative non-intubated patients, nebulized respiratory medications are preferred over MDIs
• If indicated, inhalers (MDIs) with spacers are preferred for non-intubated patients
• If indicated, nebulized medications with a closed circuit may be used in intubated patients