Updated recommendations from Ontario Health

Ontario Health’s Infectious Diseases Advisory Committee has released updated Recommendations for Antiviral Therapy for Adults with Mild to Moderate COVID-19 (April 2, 2024) based on the latest Public Health guidance.

The recommendations are intended to provide guidance for prescribers on antiviral therapy (nirmatrelvir/ritonavir and remdesivir) for adults with mild to moderate COVID-19 in the context of the Omicron subvariants and pre-existing immunity from prior infection or vaccination. Highlights include updates to COVID-19 severity classification and risk factors associated with more severe COVID-19 outcomes, along with an overview of the real-world evidence for antiviral therapies.

For patients who have symptoms of mild to moderate COVID-19 and a positive COVID-19 test, risk factors associated with more severe COVID-19 outcomes where antiviral therapy is recommended include:

  • Adults 65 years of age and older, regardless of vaccination status, with no other risk factors
  • Adults 18 years of age and older who are immunocompromised, regardless of vaccine status or prior COVID-19 infections. Selected examples include:
    • advanced untreated human immunodeficiency virus (HIV) or treated HIV with a CD4 count equal or less than 200/mm3 or CD4 fraction equal or less than 15%
    • active hematological malignancy or recently received treatment for hematological malignancy (example: have received treatment with any anti-CD20 agents or B-cell depleting agents in the last 2 years)
    • chimeric antigen receptor (CAR) T-cell therapy in the last 6 months
    • solid organ transplant, bone marrow transplant or stem cell transplant
    • treatment for cancer (including solid tumors), limited to: systemic therapy in the last 6 months (examples: chemotherapy, molecular therapy, immunotherapy, targeted therapies, monoclonal antibodies, excluding those receiving adjunctive hormonal therapy only) or radiation therapy in the last 3 months
    • prednisone use equal to or greater than 20 mg/day (or corticosteroid equivalent) for 14 days or more, or other moderately or severely immunosuppressive therapies (example: alkylating agents)
    • primary immunodeficiencies (example: hypogammaglobulinemia)

Antiviral therapy may be considered for adults with at least 1 risk factor associated with more severe COVID-19 outcomes, such as:

  • never vaccinated against COVID-19
  • certain underlying medical conditions or social vulnerabilities

For more information, click here.