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

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 high risk of severe disease (age ≥75 years or age ≥65 years 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.
4
  • 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) the following: patients who are within 1 year of receiving B-cell depleting therapies (eg, rituximab, ocrelizumab, ofatumumab, alemtuzumab); patients receiving Bruton tyrosine kinase inhibitors; chimeric antigen receptor T cell recipients; post-hematopoietic cell transplant recipients who have chronic graft versus host disease or who are taking immunosuppressive medications for another indication; patients with hematologic malignancies who are on active therapy; lung transplant recipients; patients who are within 1 year of receiving a solid-organ transplant (other than lung transplant); solid-organ transplant recipients with recent treatment for acute rejection with T- or B-cell-depleting agents; patients with severe combined immunodeficiencies; patients with untreated HIV who have a CD4 T lymphocyte cell count <50 cells/mm3. 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: National Institutes of Health. The COVID-19 Treatment Guidelines Panel's Interim Statement on Patient Prioritization for Outpatient Anti-SARS-CoV-2 Therapies or Preventive Strategies When There Are Logistical or Supply Constraints. Available at: https://www.covid19treatmentguidelines.nih.gov/therapies/statement-on-patient-prioritization-for-outpatient-therapies/ (Accessed on December 28, 2021).
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