Bottom line: Patients who have severe COVID-19 with signs of systemic inflammation and hypoxemia should be considered for tocilizumab treatment in conjunction with systemic steroids. Baricitinib requires further research but may (or may not) be a reasonable adjunct in patients with systemic inflammation and hypoxemia.

Pharmacoequity

Regardless of the agent, pharmacoequity (“Ensuring that all individuals, regardless of race and ethnicity, socioeconomic status or availability of resources, have access to the highest-quality medications required to manage their health needs,” according to Stacie Dustezina, PhD) is a paramount consideration. There is emerging evidence of racial disparities in the administration of monoclonal antibodies, remdesivir and dexamethasone.¹³ Communities of color have been disproportionately affected by COVID-19 throughout the pandemic. We must ensure that all patients have access to the best available treatments. The need for antiviral medications and mAbs to be started very early in the disease course is particularly challenging because of the numerous obstacles to overcome to reach those treatments.¹⁴Streamlining the process to get tested and access medications as well as reducing or eliminating costs are critical to achieving pharmacoequity.

References

1. RECOVERY Collaborative Group. Casirivimab and imdevimab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet.2022;399(10325):665-676.

2. Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the treatment of COVID-19 – final report. N Engl J Med. 2020;383(19):1813-1826. 

3. WHO Solidarity Trial Consortium, Pan H, Peto R, et al. Repurposed antiviral drugs for COVID-19 – interim WHO Solidarity Trial results. N Engl J Med. 2021;384(6):497-511.

4. Ader F, Bouscambert-Duchamp M, Hites M, et al. Remdesivir plus standard of care versus standard of care alone for the treatment of patients admitted to hospital with COVID-19 (DisCoVeRy): a phase 3, randomised, controlled, open-label trial. Lancet. 2021;22(2):209-221.

5. Gottlieb RL, Vaca CE, Paredes R, et al. Early remdesivir to prevent progression to severe COVID-19 in outpatients. N Engl J Med. 2022;386(4):305-315. 

6. Bernal AJ, Gomes da Silva MM, Musungaie DB, et al. Molnupiravir for oral treatment of COVID-19 in nonhospitalized patients. N Engl J Med. 2022;386(6):509-520.

7. Hammond J, Leister-Tebbe H, Gardner A, et al. Oral mirmatrelvir for high-risk, nonhospitalized adults with COVID-19 [published online ahead of print February 16, 2022]. N Engl J Med.

8. RECOVERY Collaborative Group, Horby P, Lim WS, et al. Dexamethasone in hospitalized patients with COVID-19. N Engl J Med. 2021;384(8):693-704.