Future Directions in Outpatient Therapy for Mild to Moderate Covid-19

ABSTRACT

Robust efforts to rapidly develop outpatient therapies for acute COVID-19 leveraged existing platforms and small molecule antivirals originally developed for other viral infections to rapidly identify multiple effective therapies that reduce risk for hospitalization and death in persons at increased risk for severe COVID-19 and have been authorized for this use. These have included single and combination anti-SARS-CoV-2 monoclonal antibodies (mAbs), remdesivir, nirmatrelvir/ritonavir, molnupiravir, and convalescent plasma in select populations. However, the limitations of mAbs became evident early, and none are currently authorized for use in the U.S. The remaining available therapies each have limitations, such as drug-drug interactions, challenges with administration, or uncertain and potentially lower efficacy. In this presentation, we will discuss the evidence for antiviral therapy for mild-to-moderate COVID-19 - who should be treated - in today's context of vaccinations, prior infections, and lower hospitalization and death rates. We will also discuss selection of therapy for immunocompromised persons and touch on the COVID-19 therapeutics pipeline and current challenges in outpatient COVID-19 clinical trial design.