Your outpatient has COVID-19: what are their treatment options in the current SARS-CoV-2 variant climate?

Mutations accumulated by novel SARS-CoV-2 Omicron sublineages contribute to evasion of previously effective monoclonal antibodies for treatment or prevention of COVID-19. Other authorized or approved antiviral drugs such as nirmatrelvir/ritonavir, remdesivir, and molnupiravir are, however, predicted to maintain activity against these sublineages and are key tools to reduce severe COVID-19 outcomes in vulnerable populations. A stepwise approach may be taken to target the appropriate antiviral drug to the appropriate patient, beginning with identifying whether a patient is at high risk for hospitalization or other complications of COVID-19. Among higher-risk individuals, patient profile (including factors such as age, organ function, and comedications) and antiviral drug access inform suitable antiviral drug selection. When applied in targeted fashion, these therapies serve as a complement to vital ongoing non-pharmaceutical interventions and vaccination strategies that reduce morbidity and maximize protection against COVID-19.