ACP issues Rapid, Living Practice Points on treating COVID-19 patients in outpatient settings

Abstract: https://www.acpjournals.org/doi/10.7326/M22-2249
Editorial: https://www.acpjournals.org/doi/10.7326/M22-3317
URL goes live when the embargo lifts

 

In a new Rapid and Living Practice Points, the American College of Physicians (ACP) summarizes the best available evidence about the use of pharmacologic and biologic treatments of COVID-19 in the outpatient setting. Outpatient Treatment of Confirmed Mild or Moderate COVID-19: Living and Rapid Practice Points from the American College of Physicians (Version 1), is published in Annals of Internal Medicine.

The ACP’s Practice Points focus on patients who can be managed in outpatient settings. Treatments evaluated include antibiotics, antiparasitic agents, antivirals, convalescent plasma, corticosteroids, fluvoxamine and monoclonal antibodies. In the Practice Points, ACP suggests that clinicians consider using the following antiviral treatments in patients with confirmed mild to moderate COVID-19 who are at a high risk for progressing to severe disease:

• Molnupiravir within 5 to 7 days of the onset of symptoms
• Nirmatrelvir-ritonavir combination therapy within 5 days of onset of symptoms
• Remdesivir within 7 days of the onset of symptoms

ACP suggests against the use of certain monoclonal antibodies (casirivimab-imdevimab combination therapy, regdanvimab, sotrovimab) unless it is considered effective against a SARS-CoV-2 variant or subvariant locally in circulation. Finally, ACP suggests against the use of the other reviewed treatments: azithromycin, chloroquine or hydroxychloroquine, convalescent plasma, ciclesonide, fluvoxamine, ivermectin, nitazoxanide, lopinavir-ritonavir combination therapy, or sotrovimab.

The Practice Points note that the informed decision to initiate treatment for COVID-19 in the outpatient setting should be personalized and based on clinical judgment and an informed decision-making approach with the patient on potential treatment benefits, harms, patient level-factors (e.g. risk factors, comorbid conditions, disease severity), and patient preferences.

These Practice Points are based on a systematic review conducted by the ACP Center for Evidence Reviews at Cochrane Austria/University for Continuing Education Krems (Danube University Krems). ACP’s Practice Points are developed by ACP’s Scientific Medical Policy Committee and provide advice to improve the health of individuals and populations and promote high value care based on the best available evidence derived from assessment of scientific work (e.g. clinical guidelines, systematic reviews, individual studies). ACP Practice Points aim to address the value of screening and diagnostic tests and therapeutic interventions for various diseases, and consider known determinants of health, including but not limited to genetic variability, environment, and lifestyle. ACP’s Scientific Medical Policy Committee will maintain these practice points as living by monitoring and assessing the impact of new evidence and updating them as needed.

 

Media contacts: For an embargoed PDF, please contact Angela Collom at [email protected]. To speak with someone from ACP, please contact [email protected].