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New recommendation Pre-prints of four randomised trials (from a larger adaptive randomised master protocol) among patients with non-severe illness, and the RECOVERY trial among severe and critically ill patients, triggered this guideline update. This resulted in a conditional recommendation to use a combination of casirivimab and imdevimab in non-severe patients for those at highest risk of severe disease. The RECOVERY trial included a crucial subgroup analysis demonstrating differential benefits (effect modification) associated with serological status. The Guideline Development Group (GDG) made a second conditional recommendation to use casirivmab-imdevimab in patients with severe and critical infection, if the individual has seronegative status.
Prior recommendations (a) A strong recommendation for interleukin-6 receptor blockers (tocilizumab or sarilumab) in patients with severe or critical covid-19; (b) a recommendation not to use ivermectin in patients with covid-19, regardless of disease severity, except in the context of a clinical trial; (c) a strong recommendation against the use of hydroxychloroquine in patients with covid-19, regardless of disease severity; (d) a strong recommendation against the use of lopinavir-ritonavir in patients with covid-19, regardless of disease severity; (e) a strong recommendation for systemic corticosteroids in patients with severe and critical covid-19; (f) a conditional recommendation against systemic corticosteroids in patients with non-severe covid-19; and (g) a conditional recommendation against remdesivir in hospitalised patients with covid-19.