Therapeutics and COVID-19: living guideline

Published by World Health Organization on Jan 5, 2024

View

Disclaimer

Sponsors

Contact

Abstract

© World Health Organization 2023

Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial- ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). 

Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. 

Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization (http://www.wipo.int/amc/en/mediation/rules/). 

Suggested citation. Therapeutics and COVID-19: living guideline, 10 November 2023. Geneva: World Health Organization; 2023 (WHO/2019-nCoV/therapeutics/2023.2). Licence: CC BY-NC-SA 3.0 IGO. 

Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. 

Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see https://www.who.int/copyright. 

Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. 

General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. 

The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. 

All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. 


WHO continues to monitor the situation closely for any changes that may affect this interim guidance. Should any factors change, WHO will issue a further update. Otherwise, this interim guidance document will expire 2 years after the date of publication. 

Language

en

PICOS

PICO 10.1

Population
Patients with severe or critical COVID-19
Intervention
Systemic corticosteroids
Comparator
Standard care
Outcomes

PICO 10.1

Population
Patients with non-severe COVID-19
Intervention
VV116
Comparator
Standard care
Outcomes

PICO 10.1

Population
Patients with non-severe COVID-19
Intervention
Nirmatrelvir-ritonavir
Comparator
Standard care
Outcomes

PICO 10.2

Population
Patients with severe COVID-19
Intervention
Steroids
Comparator
Standard care
Outcomes

PICO 10.2

Population
Patients with non-severe COVID-19 OUTDATED
Intervention
Nirmatrelvir-ritonavir
Comparator
No nirmatrelvir-ritonavir
Outcomes

PICO 10.3

Population
Patients with critical COVID-19
Intervention
Steroids
Comparator
Standard care
Outcomes

PICO 10.3

Population
Patients with non-severe COVID-19 OUTDATED
Intervention
Nirmatrelvir-ritonavir
Comparator
Molnupiravir
Outcomes

PICO 10.4

Population
Patients with non-severe COVID-19 OUTDATED
Intervention
Remdesivir
Comparator
Nirmatrelvir-ritonavir
Outcomes

PICO 10.4

Population
Patients with COVID-19 infection (all disease severities)
Intervention
Steroids
Comparator
Standard care
Outcomes

PICO 10.5

Population
Patients with critical, severe, non-severe COVID-19 infection [Mortality]
Intervention
Steroids
Comparator
Standard care
Outcomes

PICO 20.1

Population
Patients with non-severe COVID-19
Intervention
Ivermectin
Comparator
Standard care
Outcomes

PICO 20.1

Population
Patients with non-severe COVID-19
Intervention
Remdesivir
Comparator
Standard care
Outcomes

PICO 20.1

Population
Patients with severe or critical COVID-19
Intervention
IL-6 receptor blockers
Comparator
Standard care
Outcomes

PICO 20.2

Population
Patients with COVID-19 (all disease severities)
Intervention
Ivermectin
Comparator
Standard care
Outcomes

PICO 20.2

Population
Patients with COVID-19 infection (all disease severities)
Intervention
IL-6 receptor blockers
Comparator
Standard care
Outcomes

PICO 20.2

Population
Patients with COVID-19 (all disease severities) OUTDATED
Intervention
Remdesivir
Comparator
Standard care
Outcomes

PICO 20.3

Population
Patients with COVID-19 (all disease severities)
Intervention
Tocilizumab + steroids
Comparator
Sarilumab + steroids
Outcomes

PICO 20.3

Population
Patients with non-severe COVID-19 OUTDATED DO NOT USE
Intervention
Remdesivir
Comparator
No remdesivir
Outcomes

PICO 20.4

Population
Patients with COVID-19 infection (mortality subgroup analysis) OUTDATED
Intervention
Remdesivir + usual care
Comparator
Usual care
Outcomes

PICO 20.5

Population
Patients with non-severe COVID-19 infection OUTDATED
Intervention
Remdesivir + usual care
Comparator
Usual care
Outcomes

PICO 20.6

Population
Patients with non-severe COVID-19 infection OUTDATED
Intervention
Remdesivir
Comparator
Nirmatrelvir-ritonavir
Outcomes

PICO 20.7

Population
Patients with non-severe COVID-19 [Feb23 Update] OUTDATED
Intervention
Remdesivir
Comparator
Standard care
Outcomes

PICO 20.8

Population
Patients with non-severe COVID-19 infection OUTDATED
Intervention
Remdesivir
Comparator
Molnupiravir
Outcomes

PICO 20.9

Population
Patients with non-severe COVID-19 OUTDATED
Intervention
Remdesivir
Comparator
Molnupiravir
Outcomes

PICO 20.10

Population
Patients with COVID-19 (all disease severities) - UPDATED 28 JANUARY 2022 OUTDATED
Intervention
Remdesivir
Comparator
Standard care
Outcomes

PICO 30.1

Population
Patients with severe or critical COVID-19
Intervention
Baricitinib
Comparator
Standard care
Outcomes

PICO 30.1

Population
Patients with non-severe COVID-19
Intervention
Molnupiravir
Comparator
Standard care
Outcomes

PICO 30.1

Population
Patients with non-severe COVID-19
Intervention
Convalescent plasma
Comparator
Standard care
Outcomes

PICO 30.2

Population
Patients with severe or critical COVID-19
Intervention
Baricitinib
Comparator
Standard care
Outcomes

PICO 30.2

Population
Patients with severe or critical COVID-19
Intervention
Convalescent plasma
Comparator
Standard care
Outcomes

PICO 30.2

Population
Patients with non-severe COVID-19
Intervention
Molnupiravir
Comparator
Nirmatrelvir-ritonavir
Outcomes

PICO 30.3

Population
Patients with non-severe COVID-19
Intervention
Molnupiravir
Comparator
Remdesivir
Outcomes

PICO 30.3

Population
Patients with severe and critical COVID-19
Intervention
Baricitinib
Comparator
Interleukin-6 receptor blockers
Outcomes

PICO 30.4

Population
Patients with severe or critical COVID-19
Intervention
Ruxolitinib
Comparator
Standard care
Outcomes

PICO 30.4

Population
Patients with non-severe COVID-19
Intervention
Nirmatrelvir-ritonavir
Comparator
Remdesivir
Outcomes

PICO 30.5

Population
Patients with non-severe COVID-19 [ARCHIVE - do not use] OUTDATED
Intervention
Molnupiravir
Comparator
Standard care
Outcomes

PICO 30.5

Population
Patients with severe or critical COVID-19
Intervention
Tofacitinib
Comparator
Standard care
Outcomes

PICO 30.6

Population
Patients with non-severe COVID-19 OUTDATED
Intervention
Molnupiravir
Comparator
Standard care
Outcomes

PICO 30.6

Population
Patients with severe or critical COVID-19 OUTDATED
Intervention
Baricitinib
Comparator
Standard care
Outcomes

PICO 40.1

Population
Patients with non-severe COVID-19
Intervention
Systemic corticosteroids
Comparator
Standard care
Outcomes

PICO 40.1

Population
Patients with severe or critical COVID-19
Intervention
Remdesivir
Comparator
No remdesivir
Outcomes

PICO 40.1

Population
Patients with COVID-19 (all disease severities)
Intervention
Lopinavir-ritonavir
Comparator
Standard care
Outcomes

PICO 40.2

Population
Patients with severe COVID-19
Intervention
Remdesivir
Comparator
No remdesivir
Outcomes

PICO 40.2

Population
Patients with COVID-19 (all disease severities) - UPDATED JANUARY 28 2022 OUTDATED
Intervention
Lopinavir/ritonavir
Comparator
Standard care
Outcomes

PICO 40.3

Population
Patients with critical COVID-19
Intervention
Remdesivir
Comparator
No remdesivir
Outcomes

PICO 40.4

Population
Patients with severe COVID-19 infection OUTDATED
Intervention
Remdesivir + usual care
Comparator
Usual care
Outcomes

PICO 40.5

Population
Patients with critical COVID-19 infection OUTDATED
Intervention
Remdesivir + usual care
Comparator
Usual care
Outcomes

PICO 50.1

Population
Patients with COVID-19 (all disease severities)
Intervention
Hydroxychloroquine
Comparator
Standard care
Outcomes

PICO 50.1

Population
Patients with non-severe COVID-19
Intervention
Fluvoxamine
Comparator
No fluvoxamine
Outcomes

PICO 50.2

Population
Patients with COVID-19 infection (all disease severities) OUTDATED
Intervention
Hydroxychloroquine + azithromycin usual care
Comparator
Usual care
Outcomes

PICO 50.2

Population
Patients with non-severe COVID-19
Intervention
Fluvoxamine
Comparator
Nirmatrelvir-ritonavir
Outcomes

PICO 50.3

Population
Patients with COVID-19 infection (all disease severities) OUTDATED
Intervention
Hydroxychloroquine + usual care
Comparator
Usual care
Outcomes

PICO 50.3

Population
Patients with non-severe COVID-19
Intervention
Fluvoxamine
Comparator
Molnupiravir
Outcomes

PICO 50.4

Population
Patients with non-severe COVID-19
Intervention
Fluvoxamine
Comparator
Remdesivir
Outcomes

PICO 60.1

Population
Patients with non-severe COVID-19 OUTDATED
Intervention
Casirivimab-imdevimab
Comparator
Standard care
Outcomes

PICO 60.1

Population
Patients with non-severe COVID-19 OUTDATED
Intervention
Sotrovimab
Comparator
Standard care
Outcomes

PICO 60.2

Population
Patients with severe or critical COVID-19, seronegative OUTDATED
Intervention
Casirivimab-imdevimab
Comparator
Standard care
Outcomes

PICO 60.2

Population
Patients with non-severe COVID-19 OUTDATED
Intervention
Sotrovimab
Comparator
Casirivimab-imdevimab
Outcomes

PICO 60.3

Population
Patients with severe or critical COVID-19 OUTDATED
Intervention
Casirivimab-imdevimab
Comparator
Standard care
Outcomes

PICO 60.4

Population
BY RISK (not used) - Patients with non-severe COVID-19 OUTDATED
Intervention
Casirivimab and imdevimab
Comparator
No casirivimab and imdevimab
Outcomes

PICO 60.5

Population
Patients with COVID-19 (all severities) OUTDATED
Intervention
Casirivimab and imdevimab
Comparator
No casirivimab and imdevimab
Outcomes

PICO 60.6

Population
Patients with non-severe COVID-19 - UPDATED Feb 9 2022 OUTDATED
Intervention
Casirivimab-imdevimab
Comparator
Standard care
Outcomes

PICO 60.7

Population
Patients with severe or critical COVID-19 - UPDATED 09 FEB 2022 OUTDATED
Intervention
Casirivimab-imdevimab
Comparator
Standard care
Outcomes

PICO 70.1

Population
Patients with non-severe COVID-19
Intervention
Colchicine
Comparator
Standard care
Outcomes

PICO 70.1

Population
Patients with severe COVID-19 OUTDATED
Intervention
Therapeutic anticoagulation
Comparator
Up to prophylactic anticoagulation
Outcomes

PICO 70.2

Population
Patients with critical COVID-19 OUTDATED
Intervention
Therapeutic anticoagulation
Comparator
Up to prophylactic anticoagulation
Outcomes

PICO 70.3

Population
Patients with non-severe COVID-19 OUTDATED
Intervention
Colchicine
Comparator
No colchicine
Outcomes

PICO 70.4

Population
Patients with non-severe COVID-19 OUTDATED
Intervention
Colchicine
Comparator
No colchicine
Outcomes

PICO 70.5

Population
Patients with severe COVID-19 OUTDATED
Intervention
Colchicine
Comparator
No colchicine
Outcomes

PICO 70.6

Population
Patients with severe or critical COVID-19 OUTDATED
Intervention
Janus kinase inhibitors
Comparator
No Janus kinase inhibitor
Outcomes

PICO 70.7

Population
Patients with severe or critical COVID-19 OUTDATED
Intervention
Janus kinase inhibitors
Comparator
Interleukin-6 receptor blockers with glucocorticoids
Outcomes

PICO 70.8

Population
Patients with non-severe COVID-19 OUTDATED
Intervention
Convalescent plasma
Comparator
No convalescent plasma
Outcomes

PICO 70.9

Population
Patients with severe and critical COVID-19 OUTDATED
Intervention
Ruxolitinib
Comparator
Interleukin 6-receptor blockers
Outcomes

PICO 70.10

Population
Patients with severe and critical COVID-19 OUTDATED
Intervention
Tofacitinib
Comparator
Interleukin 6-receptor blockers
Outcomes

PICO 70.11

Population
Patients with non-severe COVID-19 (pairwise for comparison - do NOT use)
Intervention
Colchicine
Comparator
Standard care
Outcomes

PICO 70.12

Population
Patients with severe or critical COVID-19 OUTDATED
Intervention
Therapeutic anticoagulation
Comparator
Intermediate anticoagulation
Outcomes

PICO 70.13

Population
Patients with severe or critical COVID-19 OUTDATED
Intervention
Therapeutic anticoagulation
Comparator
Prophylactic anticoagulation
Outcomes

PICO 70.14

Population
Patients with severe or critical COVID-19 OUTDATED
Intervention
Intermediate anticoagulation
Comparator
Prophylactic anticoagulation
Outcomes