COVID-19 Treatment Update – June 2022

In this edition of Grand Rounds in Hematology and Oncology from June 2022, Hillary Maitland, Emily Couric Clinical Cancer Center, University of Virginia, Charlottesville, Virginia, introduces Patrick E. H. Jackson, MD, Division of Infectious Disease & International Health, Myles H. Thaler Center for AIDS and Human Retrovirus Research University of Virginia, Charlottesville, Virginia.  In this 49-minute presentation, Dr. Jackson provides a detailed overview of current therapeutic options for COVID-19, distinguishing between outpatient and inpatient care strategies. The presentation ends with a short Q&A discussion.

Dr. Jackson emphasizes early treatment within the first five days of symptoms. Nirmatrelvir/ritonavir (Paxlovid) is highlighted as the preferred option due to its robust efficacy in preventing hospitalization and death. Remdesivir, administered over three days intravenously, is considered a suitable alternative for those unable to take Paxlovid.

For hospitalized patients, therapeutic goals shift from antiviral activity to immunomodulation. Remdesivir may still be used in early illness, but the focus moves to corticosteroids like dexamethasone, which remain standard for those requiring oxygen. Tocilizumab and baricitinib, both immune modulators, are added in more severe cases. The presentation also underscores that clinical trials have shown no benefit from drugs like fluvoxamine, hydroxychloroquine, ivermectin, colchicine, and azithromycin, which are no longer recommended.

The speaker also discusses NIH COVID-19 treatment guidelines, which reflect these evidence-based preferences, and highlights ongoing research into long-acting monoclonal antibodies and novel antivirals. The overarching message is that timely access to appropriate therapies—especially for high-risk individuals—is essential to improving outcomes, and healthcare providers must stay up-to-date on emerging resistance patterns and trial data to make informed treatment decisions.