There is currently very limited evidence to support the use of antiviral medications for the treatment of COVID-19.
Preliminary results from a number of (mostly Chinese) trials are due to be published by end March 2020, and will be used to update this Guidance document.
There are no current recommendations to treat patients with mild or moderate COVID-19 illness, nor to use prophylactically in known close contacts of confirmed cases.
For deteriorating or critically ill patients, consensus amongst a panel of NSW Health Infectious Disease, Respiratory and Intensive Care experts is that:
- good supportive care is current best practice
- antiviral therapy for COVID-19 is considered experimental at this stage. There are no antiviral medications with approved indications to treat COVID-19.
- antiviral therapy should only be prescribed as part of a clinical trial. Two clinical trials will be available to NSW clinicians by the end of March 2020 (see below for more information)
- in the interim, treating clinicians who elect to prescribe off-label antiviral therapy on a case-by-case basis in NSW should only consider:
- Kaletra (lopinavir / ritonavir) +/- hydroxychloroquine
- currently there are no indications to prescribe drugs such as ribavirin, interferons, anti-IL-6 agents, oseltamivir or corticosteroids for COVID-19 illness alone. Oseltamivir has a role if there is co-infection with influenza; corticosteroids have other indications in critically ill patients.
- Remdesivir has anecdotally shown promise and a clinical trial will report preliminary results shortly. Remdesivir is currently unavailable in Australia. NSW Health is investigating options for supply of this medication.
Two trials of antiviral therapies for COVID-19 in NSW are commencing by end March 2020, and will be supported by NSW Health:
- REMAP-CAP: ICU patients. Arms: Kaletra, hydroxychloroquine, both or none
- ASID: ward patients. Arms: Kaletra, hydroxychloroquine, both or none
NSW Health has taken steps to procure more Kaletra and hydroxychloroquine.
All cases should be discussed individually with your local medical experts.
This guidance will be updated regularly as new information becomes available.