Table 1 Selected current treatments for non-pregnant adult patients hospitalized for COVID-19 (adapted from ref.¹⁵³, Springer Nature Limited)

Corticosteroids

Dexamethasone

Hospitalized patients; increases organ support-free days and reduces 28-day mortality

Recommended

^154,155,156

Janus kinase (JAK) inhibitors

Baricitinib (with IL-6 inhibitor and dexamethasone)

Patients with moderate–severe illness; rapid declines of C-reactive protein, ferritin and D-dimer with gradual improvement in haemoglobin, platelet counts and clinical status

At least 2 large RCTs; high likelihood of benefit

¹⁵⁷

IL-6 inhibitors

Toclizumab

Hospitalized patients; reduces inflammatory markers, D-dimer and fibrinogen; reduced 21 or 28-day mortality and organ support-free days

For critically and severely ill patients; widely used

¹⁵⁸

Anticoagulants

Low molecular weight heparin (LMWH) — prophylactic intensity

Critically ill patients (hospitalized, intensive care unit) for venous thromboemboli prophylaxis and to increase the number of organ support-free days; no effect on survival to hospital discharge

Certainty of evidence from multiple trials is low; but widely used

^{154,155,156,159}

LMWH — therapeutic dose

Patients with moderate-severity illness (hospitalized, low-flow oxygen use, elevated D-dimer) for venous/arterial thromboemboli prophylaxis and to reduce organ support-free survival; uncertain if an effect on survival; consider bleeding risk

Certainty of evidence from multiple trials is low; but widely used

^{154,155,156,159}

Rivaroxaban (or other direct oral anticoagulants)

Patients with moderate-severity illness; no effect on survival or need for supplemental oxygen

Not recommended

^154,160

Anti-platelets

Aspirin, P2Y12 inhibitors

Early use of ASA may lower odds of 28-day in-hospital mortality; no benefit from P2Y12 inhibitors

Not recommended

^104,161,162

Thrombolytics

Alteplase (tPA)

For respiratory failure with heparin; evidence of moderate improved oxygenation

Early phase

¹⁶³

Anti-spike protein monoclonal antibodies

Casirivumab and imdevimab

Hospitalized patients; may reduce 28-day mortality

Uncertain which patient groups will benefit most

¹⁶⁴

Anti-complement

Inhibitor of C5 activation: ravulizumab

Critically ill patients, phase III study; stopped due to lack of clinical benefit

No clinical benefit

⁸¹

Inhibitor of C5 activation: zilucoplan

Patients with moderate-severity illness; improved oxygenation at day 15, reduced cytokine levels and reduced 28-day mortality

Underpowered

¹⁶⁵

C5a blockade: (e.g., violbelimab, BDB-001); C5a-receptor blockage (avdoralimab)

Hospitalized patients; evidence of improvements in oxygenation

Early phase or underpowered studies

⁸¹

C3 inhibitors (e.g., AMY-101, APL9), C1-esterase inhibitor, MASP2 antibody (narsoplimab)

Hospitalized patients; evidence of improvements in oxygenation

Early phase or underpowered studies

^70,160

Bradykinin-targeted

Icatibant (bradykinin 2 receptor antagonist), ecallantide (kallikrein inhibitor)

Icatibant ± C1-esterase inhibitor; evidence of improvements in oxygenation

Underpowered

¹⁶⁴