IDSA Releases New Guidelines For COVID-19 Treatment

The Infectious Diseases Society of America has recently updated their list of COVID-19 guidelines for the treatment and management of the disease. The list, which describes different ways to treat and manage COVID-19, includes revisions in the information on lopinavir/ritonavir, tocilizumab, remdesivir and bamlanivimab.

Led by Adarsh Bhimraj, MD., associate staff physician in the Department of Infectious Disease at the Cleveland Clinic in Ohio, the panel of experts in the field of infectious disease agreed upon the new guidelines to aid in the information available on the treatment and management of COVID-19.

Lopinavir/ritonavir is a protease inhibitor, a class of antiviral drugs which are used to treat HIV, Aids and hepatitis C, by preventing a virus from replicating and blocking a protein necessary for the production of viral particles. The antiviral class was approved by the FDA in September of 2000. In the early stages of the COVID-19 outbreak, an open-label, randomized, phase II trial researching a triple combination of interferon beta-1b, lopinavir-ritonavir, and ribavirin was shown to shorten the duration of viral shedding, as well as how long patients with mild to moderate COVID-19 symptoms stayed in the hospital. However, the panel ultimately decided to recommend against the use of lopinavir/ritonavir, due to concerns with the imprecision of the evidence.

Remdesivir, an antiviral drug with potent in vitro activity against a range of RNA viruses, acts by causing an early cessation of viral RNA transcription. In a study with rhesus macaques, the therapeutic treatment with remdesivir was shown to reduce the level of SARS-CoV-2 loads, pathologic changes and progression of clinical disease. The study also demonstrated that a remdesivir treatment initiated 12 hours of post-inoculation reduced clinical signs, virus replication in the lungs, and a decreased presence of severity in lung lesions. The panel concluded that the treatment should not be given to patients with an oxygen saturation level of >94% and no supplemental oxygen.

Bamlanivimab is a type of neutralizing monoclonal antibody. This type of therapy is directed at the receptor-binding domain of SARS-CoV-2 spike protein, which has been identified as a potential therapeutic prophylactic. Animal models have shown that there is evidence to support that antibody therapy rapidly reduces the viral load in the upper and lower airways of infected animals, which results in a reduced viral-induced pathology. The panel agreed that there was not enough evidence to recommend bamlanivimab as a routine treatment for COVID-19.

Tocilizumab, a monoclonal anti-IL-6-receptor blocking antibody, has been advanced as a therapeutic approach to reduce hyperinflammation that has been associated with COVID-19. The therapy has been FDA-approved for various rheumatologic conditions, as well as cytokine release syndrome associated with CAR-T cell therapy. There have been patients diagnosed with COVID-19 who have been documented with a hyperinflammatory syndrome, characterized by elevations in proinflammatory cytokines and multiorgan dysfunction. Earlier studies have found that those with elevated Il-6 levels and evidence of hyperinflammation had increased rates of more severe disease and Tocilizumab has been put forward as a possible therapy. The panel advises against treatment with Tocilizumab, due to its low likelihood of a meaningful effect.