COVID-19 FAQs: Medications and Treatments

News, scientific understanding and guidelines about COVID-19 are continually evolving. This information is current as of Jan. 4, 2023.

Question: What are monoclonal antibodies and who qualifies for them to treat and prevent COVID-19?

A: Monoclonal antibodies are laboratory-made proteins that mimic the immune system’s ability to fight viruses. In the first two years of the pandemic, millions of people were treated with these medications, especially those who were hospitalized, likely to get very sick or immunocompromised. 

However, monoclonal antibodies are not effective against widely circulating omicron subvariants. In November 2022, the FDA ended its emergency authorization for bebtelovimab, the last remaining monoclonal antibody used in the U.S. 

Evusheld, a combination of two monoclonal antibodies, was designed specifically for pre-exposure defense in immunosuppressed people who don’t respond well to vaccines. Although Evusheld is still available, the FDA issued a warning in October 2022 that it was not effective against most omicron subvariants, which currently account for most cases in the U.S.
                                                 
Question: Should I stop or reduce my arthritis drug(s) if I have COVID-19?

A: Certain medications may need to be temporarily stopped if you have a confirmed infection, have been exposed to someone with a COVID-19 infection or are experiencing common COVID-19 symptoms, which vary.

Don’t stop or change medication dosage without checking with your doctor. This is especially important with corticosteroids, which should never be stopped suddenly. The American College of Rheumatology has coronavirus medication guidelines for both adult and pediatric rheumatology patients.

If you have symptoms of COVID-19 or think you’ve been exposed to the virus, contact your health care provider right away to help you decide the best course of action.

Question: How is COVID-19 treated? 

A: There is no cure for COVID-19, but doctors may prescribe various treatments to speed up recovery, including:

Antiviral drugs. Remdesivir (Veklury) is the only FDA-approved treatment for COVID-19. It’s meant for adults and kids who are likely to become very sick. Remdesivir is given by infusion over a period of three days, making it inconvenient or inaccessible for many who may need it. Evidence suggests it may modestly speed up recovery time or prevent serious illness, although the World Health Organization (WHO) recommended against its use in November 2022, citing lack of effectiveness.

Two other antiviral treatments from Pfizer (Paxlovid) and Merck (Lagevrio) have received emergency-use authorization from the FDA. Both are pill regimens that people take for five days after testing positive for COVID-19. Experts expect them to help prevent severe illness, including against omicron subvariants, although that may change as the virus evolves. So far, Pfizer’s treatment appears to be more effective, but only for patients with at least one risk factor for very severe disease. Its effectiveness for low-risk patients isn’t clear.

A large real-world study in mid-2022 found that Paxlovid worked best in older adults, immunocompromised people and those with heart or neurological conditions, regardless of vaccination status. Yet many people take medications that interact with Paxlovid, which covers a long list, including some corticosteroids, opioids, and gout and sleep medications. And according to Pfizer’s own data, breakthrough or rebound infections are twice as common in people who take Paxlovid as in those who don’t.

Convalescent plasma. The FDA granted an emergency use authorization (EUA) for convalescent plasma — antibodies from the blood of recovered COVID patients — for certain hospitalized patients who have early-stage disease or can’t make their own antibodies. It’s not effective later in the infection. 

Dexamethasone. This commonly used corticosteroid has been shown to reduce deaths among critically ill patients on ventilators and receiving oxygen, but it can be life-threatening for people with early-stage infections or who aren’t as sick.

Ultimately, the decision to treat COVID-19 with any drug depends on shared decision-making between patients and doctors. In general, doctors recommend caution when patients have poor liver or kidney function unless the potential benefits of using the drug significantly outweigh potential risks.