Drugs | Key issues to consider | Strength of recommendation |
---|---|---|
Antiviral drugs | The duration and course of antiviral treatment can be appropriately prolonged. | Â |
 Nirmatrelvir and ritonavir  (Paxlovid)  (Target: 3CL) | It is essential to monitor for drug-drug interactions, and the dosage should be modified in accordance with renal function. The COVID-19 drug interactions query website is https://covid19-druginteractions.org/checker. | Strong |
 Remdesivir*  (Target: RdRp) | Remdesivir should not be taken if ALT > 10 ×ULN or if ALT levels are increased and there are symptoms of active hepatitis. | Weak or conditional |
 Molnupiravir  (Target: RdRp) | No dose adjustment is required for renal or hepatic impairment. | Weak or conditional |
 Azvudine  (Target: RdRp) | It is not recommended to use during pregnancy or lactation. Patients with moderately to severely impaired liver and kidney function should use it with caution. | Weak or conditional |
Monoclonal antibodies | Patients with major risk factors for disease progression, high viral loads, and rapid disease development (depending upon predominant circulating viral variants). | Â |
 Bebtelovimab* | It is effective against all Omicron subvariant virus strains (including BA.1, BA.1.1, and BA.2). | Weak or conditional |
 Tixagevimab/cilgavimab* | It is only recommended for preexposure prophylaxis. | Weak or conditional |
Convalescent plasma | The patient’s individual condition and viral load should be considered while determining whether to administer again. | Weak or conditional |
Human COVID-19 immunoglobulin | Patients with major risk factors for disease progression, high viral loads, and rapid disease development. According to the patient’s condition, it can be infused once again the next day; the total number of infusions should be no more than 5. | Weak or conditional |
Immunoregulatory drugs | Â | Â |
Corticosteroids | Patients with critical and severe conditions that display rapid imaging progression, a body inflammatory response that is aggressive, and a steadily declining oxygenation index. The early use of systemic corticosteroids for severe and critical patients is emphasized. Patients with severe CRS could benefit from high-dose corticosteroid therapy. | Â |
 Dexamethasone | The dosage of dexamethasone should be adjusted to the severity of CRS. The dosage can be appropriately increased to 10 mg/6 h for 1–3 days in patients with ICANS. | Strong |
 Methylprednisolone | If ICANS symptoms are still not relieved following the use of dexamethasone, methylprednisolone may be administered. The dosage of methylprednisolone is 1000 mg/day for 3 days, 250 mg × 2/day for 2 days, 125 mg × 2/day for 2 days, and 60 mg × 2/day for 2 days. | Strong |
IL-6 inhibitors | Â | Â |
 Tocilizumab | If CRS is exacerbated, combination therapy with IL-6 inhibitor tocilizumab (8 mg/kg) is recommended. Tocilizumab should be used with caution in the case of ICANS. | Strong |
JAK inhibitors | Â | Â |
 Baricitinib | Attention should be given to symptoms and warning indications of thromboembolic events, and coagulation indicators should be identified when necessary. | Strong |
 Ruxolitinib | Most clinical criteria, symptoms (such as respiratory distress or the need for oxygen), and other clinical indications are used to determine whether to begin the use of ruxolitinib. | Weak or conditional |
IVIGs | It is recommended for hypogammaglobulinemia (IgG < 4 g/l). | Strong |