## Summary of COVID-19 Therapies (Based on Provided Text)

COVID-19 Treatment Options: Medications Doctors Prescribe

Antiviral Drugs Approved for COVID‑19

Remdesivir (Veklury) – Intravenous RNA polymerase inhibitor

• Indication: Hospitalized patients with moderate‑to‑severe COVID‑19 who require supplemental oxygen but are not on invasive ventilation.
• Typical regimen: 200 mg IV on day 1, followed by 100 mg IV daily for 4‑9 days (total 5‑10 days).
• Key benefits:
• Reduces median time to clinical recovery by ~5 days in the ACTT‑1 trial (p < 0.001)【1】.
• Demonstrated mortality benefit in the WHO Solidarity trial for patients receiving oxygen support【2】.
• Common side effects: Elevated liver enzymes, nausea, infusion‑related reactions.
• Practical tip: Monitor ALT/AST before initiation and repeat every 48 h; avoid use in severe hepatic impairment (child‑pugh C).

Paxlovid (nirmatrelvir + ritonavir) – Oral protease inhibitor combo

• Indication: Non‑hospitalized adults ≥ 12 years with mild‑to‑moderate COVID‑19 at high risk for progression (e.g., age ≥ 65, immunocompromised, obesity).
• Dosage: 300 mg nirmatrelvir + 100 mg ritonavir, taken together twice daily for 5 days. Start within 5 days of symptom onset.
• Efficacy highlights:
• EPIC‑HR trial (2022) showed 89 % relative risk reduction in hospitalization or death vs. placebo【3】.
• Real‑world CDC analysis (2024) confirmed 82 % effectiveness against the BA.5‑dominant wave when administered within 3 days of onset【4】.
• Drug-drug interactions: Ritonavir is a strong CYP3A4 inhibitor; review patient medication list for statins, anti‑arrhythmics, anticonvulsants, etc. Use dose adjustments or choice therapies when necessary.
• Side effects: Dysgeusia,diarrhea,hypertension; rarely,rebound viral load after completion (generally mild).

Molnupiravir (Lagevrio) – Oral nucleoside analog

• Indication: Adults with mild‑to‑moderate COVID‑19 who are ineligible for Paxlovid or monoclonal antibodies (e.g., due to drug interactions).
• Regimen: 800 mg orally twice daily for 5 days; begin within 5 days of symptom onset.
• Clinical data: MOVe‑OUT trial reported a 30 % reduction in hospitalization or death; subsequent meta‑analysis suggests modest benefit, especially in unvaccinated cohorts【5】.
• Safety notes:
• Contraindicated in pregnancy and in patients planning conception due to potential mutagenicity.
• Monitor complete blood count in patients with baseline hematologic disorders.

Immunomodulatory Therapies

Dexamethasone – Systemic corticosteroid

• Target group: Hospitalized patients requiring supplemental oxygen or mechanical ventilation.
• Dose: 6 mg IV or PO once daily for up to 10 days (or until discharge).
• evidence: RECOVERY trial demonstrated a 12 % absolute reduction in 28‑day mortality for patients on oxygen and a 20 % reduction for those on invasive ventilation【6】.
• Practical tip: Avoid high‑dose steroids (> 6 mg dexamethasone equivalent) unless indicated for othre conditions; taper if therapy exceeds 10 days.

Baricitinib (Olumiant) – Janus kinase (JAK) inhibitor

• Indication: Hospitalized patients with progressive disease despite steroids, particularly those with elevated inflammatory markers (CRP > 75 mg/L, ferritin).
• Dosage: 4 mg PO once daily for up to 14 days; reduce to 2 mg in patients with eGFR 30‑60 mL/min/1.73 m².
• Outcomes: ACTT‑2 trial (2021) showed faster recovery when combined with remdesivir compared to remdesivir alone (median 7 vs 8 days)【7】.
• Safety: Watch for thromboembolic events; baseline D‑dimer and CBC recommended.

Tocilizumab – IL‑6 receptor antagonist (IV)

• Use case: Severe COVID‑19 with rapid respiratory decompensation and high IL‑6 levels, often administered alongside steroids.
• Regimen: Single dose of 8 mg/kg (max 800 mg) IV; a second dose may be considered 12‑24 h later if no clinical improvement.
• evidence: RECOVERY trial (2021) reported a 4 % absolute reduction in 28‑day mortality when added to standard care with dexamethasone【8】.
• Monitoring: Check liver enzymes and neutrophil count; hold if ALT > 5 × ULN or ANC < 500/µL.

Monoclonal Antibody (mAb) Therapies – Variant‑Specific

Practical tip: Verify local health authority updates on mAb susceptibility because rapid variant evolution can render a product ineffective within months.

Anticoagulation Strategies in Hospitalized Patients

• Therapeutic anticoagulation (e.g., enoxaparin 1 mg/kg BID) recommended for patients with markedly elevated D‑dimer (> 2 µg/mL) and no contraindications.
• Prophylactic dosing (e.g., enoxaparin 40 mg daily) remains standard for most hospitalized COVID‑19 patients.
• Evidence: ATTACC/ACTIV-4a/REMAP‑CAP trials (2022) demonstrated a mortality benefit of therapeutic anticoagulation in non‑ICU patients,but no benefit-and potential harm-in ICU patients【12】.

Practical Prescribing checklist for Clinicians

1. Confirm COVID‑19 diagnosis (RT‑PCR or rapid antigen) and assess disease severity.
2. Determine vaccination status – influences risk stratification and therapeutic choice.
3. review comorbidities (renal/hepatic function, immunosuppression, pregnancy).
4. Select first‑line antiviral:
• Outpatient, high‑risk → Paxlovid (preferred) → Molnupiravir (if contraindicated).
• Hospitalized, oxygen‑requiring → Remdesivir + dexamethasone.
• Check drug interactions (especially with ritonavir‑boosted regimens). Use clinical decision support tools.
• Assess inflammatory markers (CRP, ferritin, IL‑6) to decide on immunomodulators.
• Screen for contraindications to mAbs (e.g., prior allergic reaction, variant resistance).
• Initiate anticoagulation based on D‑dimer threshold and bleeding risk.
• Educate patient on symptom monitoring, potential side effects, and importance of adherence.

Benefits & Risks Overview

Real‑World Case Example (U.S., 2024)

• Population: 12,345 non‑hospitalized adults ≥ 65 y or with ≥ 2 comorbidities, infected during the BA.5 wave.