Table 3 Overview of drugs and recommendations for COVID-19 CAR-T recipients

Antiviral drugs

The duration and course of antiviral treatment can be appropriately prolonged.

 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).

 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

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.

 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

 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

 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