Prioritization for outpatient anti-SARS-CoV-2-specific therapies

Priority tier	Risk group description
1	Immunocompromised individuals not expected to mount an adequate immune response to COVID-19 vaccination or SARS-CoV-2 infection due to underlying conditions, regardless of vaccine status (refer to immunocompromising conditions below*) or Unvaccinated individuals at the highest risk of severe disease (age ≥75 years or age ≥65 years with additional risk factors).
2	Unvaccinated individuals at risk of severe disease not included in Tier 1 (age ≥65 years or age <65 years with clinical risk factors).
3	Vaccinated individuals at risk of severe disease (age ≥65 years or age <65 with clinical risk factors). NOTE: Vaccinated individuals who have not received a COVID-19 vaccine booster dose are likely at higher risk for severe disease; patients in this situation within this tier should be prioritized for treatment over those who have received a booster.

The NIH COVID-19 Treatment Guideline Panel prioritizes risk groups for anti-SARS-CoV-2-specific therapy based on 4 key elements: age, vaccination status, immune status, and clinical risk factors. The groups are listed by tier in descending order of priority.

* If anti-SARS-CoV-2-specific therapy cannot be provided to all moderately to severely immunocompromised individuals, the Panel suggests prioritizing their use for those who are least likely to mount an adequate response to COVID-19 vaccination or SARS-CoV-2 infection and who are at risk for severe outcomes, including (but not limited to) patients who:

Are receiving active treatment for solid tumor and hematologic malignancies;
Have a hematologic malignancy (eg, chronic lymphocytic leukemia, non-Hodgkin lymphoma, multiple myeloma, acute leukemia) that has been associated with poor response to COVID-19 vaccines, regardless of the patient's current treatment;
Received a solid organ or islet transplant and are receiving immunosuppressive therapy;
Received chimeric antigen receptor T cell (CAR T-cell) therapy or a hematopoietic cell transplant (HCT) and are within 2 years of transplantation or are receiving immunosuppressive therapy;
Have a moderate or severe primary immunodeficiency (eg, severe combined immunodeficiency, DiGeorge syndrome, Wiskott-Aldrich syndrome, common variable immunodeficiency disease);
Have acquired immunodeficiency syndrome (AIDS) or untreated HIV infection (defined as people with HIV and CD4 T lymphocyte [CD4] cell counts <200 cells/microL, a history of an AIDS-defining illness without immune reconstitution, or clinical manifestations of symptomatic HIV);
Are receiving active treatment with high-dose corticosteroids (ie, ≥20 mg prednisone or equivalent per day when administered for ≥2 weeks), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, or immunosuppressive or immunomodulatory biologic agents (eg, B cell-depleting agents).

If supplies are extremely limited, the Panel suggests prioritizing those who are more severely immunocompromised (refer to above list) and who also have additional risk factors for severe disease for the outpatient therapies.

Reproduced from: COVID-19 treatment guidelines: Prioritization of anti-SARS-CoV-2 therapies for the treatment of COVID-19 in nonhospitalized patients when there are logistical constraints. National Institutes of Health. Available at: https://www.covid19treatmentguidelines.nih.gov/overview/prioritization-of-therapeutics/ (Accessed on December 8, 2022).

Graphic 134702 Version 2.0

خرید پکیج

Prioritization for outpatient anti-SARS-CoV-2-specific therapies