The April 21st updates include guidance on use of colchicine, when to use combination anti-SARS-CoV-2 monoclonal antibodies, COVID-19 reinfection, and "long COVID."
The National Institutes of Health Coronavirus Disease 2019 (COVID-19) Treatment Guidelines are updated monthly and the most recent additions and revisions were released on April 21, 2021.
The following slides offer an at-a-glance review of the 3 new sections added and the 7 key updates to existing sections. Links to each section are provided in slide captions for more extensive reading.
Outpatient Management of Acute COVID-19. New section provides recommendations for screening, triage, and therapeutic management of patients with mild-to-moderate COVID-19 who do not require hospitalization. The section also provides recommendations for managing patients with COVID-19 after discharge from the emergency department or the hospital.
Colchicine. New section states that the Panel finds insufficient data to recommend either for or against the use of colchicine in nonhospitalized patients with COVID-19. The Panel recommends against the use of colchicine in hospitalized patients, except in a clinical trial.
Fluvoxamine. New section states that the The Panel has determined that there are insufficient data to recommend either for or against the use of fluvoxamine for the treatment of COVID-19.
Therapeutic Management of Adults with COVID-19. Key update added with recommendations for when to use combination anti-SARS-CoV-2 mAbs and tocilizumab (+ dexamethasone) in patients with COVID-19, based on severity.
Overview of COVID-19. Key update is a new subsection on emerging information on SARS-CoV-2 variants of concern in the US and globally.
Clinical Spectrum of SARS-CoV-2 Infection. Key updates include 2 new subsections. SARS-CoV-2 reinfection is characterized and described, including susceptible populations and guidance on testing. Persistent symptoms or organ dysfunction after acute COVID-19. The extensive section reviews existing studies on symptoms of “long COVID” and notes that there are currently no specific treatments have been identified.
Anti-SARS-CoV-2 Monoclonal Antibodies. Key update is a new subsection that incorporates Panel recommendations from EUAs for 2 combination therapies for the treatment of mild/moderate COVID-19 in nonhospitalized patients with laboratory confirmed SARS-CoV-2 infection who are at high risk for progressing to severe disease and/or hospitalization: Bamlanivimab + etesevimab and casirivimab + imdevimab.
Interleukin-6 Inhibitors. Key update is an added subsection that discusses use of tocilizumab + dexamethasone in certain hospitalized patients who are exhibiting rapid respiratory decompensation due to COVID-19. A new clinical data table summarizes the results from key studies of tocilizumab and sarilumab use in patients with COVID-19.
Convalescent Plasma. Key update is a subsection added that includes new Panel recommendations for using convalescent plasma in hospitalized and nonhospitalized COVID-19 patients.
Special Considerations in Children. Key update is an expanded discussion that includes Panel recommendations for use of specific therapies for children with COVID-19 who require hospitalization. “In the absence of adequate data on treatment of children with acute COVID-19, recommendations are based on outcome/safety data for adult patients and the child’s risk of disease progression.”
Special Considerations in Children. Note: As is true for adults, children with history of medical complexity, obesity, chronic cardiopulmonary disease, compromised immunity, nonwhite children,
and older teenagers may be at increased risk for severe disease.