Remarks

• See Section 6.1 for help to identify patients at highest risk of being hospitalized.
• Several therapeutic options are available: see decision support tool that displays benefits and harms of nirmatrelvir-ritonavir, molnupiravir, remdesivir and the monoclonal antibodies, including sotrovimab and casirivimab-imdevimab.
• The GDG concluded that nirmatrelvir-ritonavir may represents a superior choice because it may have greater efficacy in preventing hospitalization than the alternatives, has fewer concerns with respect to harms than does molnupiravir; and is easier to administer than intravenous remdesivir and the antibodies.

Practical Info Dosing and administration route: Intravenous total dose of the monoclonal antibody combination differed in the non-severe trials, ranging from total dose 1200 mg–8000 mg (600 mg–4000 mg each antibody), demonstrating efficacy at all doses, including the lowest tested, 1200 mg total dose (600 mg of each antibody). In the face of limited access and resource considerations, health systems will face choices concerning dose of casirivimab-imdevimab as well as intravenous or subcutaneous injections. Please see the acceptability and feasibility section (under Evidence to Decision) for some deliberations to help in making these choices within the possible range of 1200 mg–2400 mg total dose. Monitoring: Although the available trials have not convincingly shown that casirivimab-imdevimab results in allergic reactions, the possibility remains. To be administered through an intravenous line containing a sterile in-line or add-on 0.2 micron filter. Following administration, patients should undergo monitoring for severe anaphylaxis.