CDC Health Update: Important Updates on COVID-19 Therapeutics for Treatment and Prevention December 21, 2022 antiviral, California, California Department of Public Health, CDC, Centers for Disease Control and Prevention, cilgavimab, COVID-19, healthcare providers, LA County, LAHAN, Los Angeles, Los Angeles County Department of Public Health, Paxlovid, tixagevimab 1144 The Centers for Disease Control and Prevention (CDC) issued a Health Update to provide guidance on improving the use of therapeutics for the treatment of COVID-19 and strategies to prevent serious outcomes of COVID-19. Included in this CDC guidance are the following important points: Bebtelovimab is no longer authorized for the treatment of COVID-19 due to the current high prevalence of Omicron variants that are resistant to this monoclonal antibody treatment. There is also a high level of variants that are resistant to Evusheld (the monoclonal antibody combination, cilgavimab and tixagevimab). Despite this, because Evusheld is the only agent authorized as pre-exposure prophylaxis (PrEP), it continues to be recommended for people who are not expected to mount an adequate immune response to COVID-19 vaccination or those with contraindications for COVID-19 vaccines. Providers should make sure patients receiving Evusheld are aware of the potential for reduced effectiveness and should emphasize the need for additional prevention measures such as wearing a high-quality well-fitting mask around others and that their household members and other close contacts stay up to date with vaccinations, including getting the bivalent booster. All three of the antiviral therapeutics for the treatment of COVID-19 retain activity against currently circulating Omicron sublineages. These medications (ritonavir-boosted nirmatrelvir [Paxlovid™], remdesivir [Veklury®], and molnupiravir [Lagevrio™] can prevent severe disease, hospitalization, and death and are widely available but have been underused. In California, healthcare providers should have a low threshold to prescribe COVID-19 antiviral therapeutics given the broad range of individuals who are at higher risk for severe COVID-19 and can benefit from COVID-19 treatment including: Being unvaccinated or not being up to date on COVID-19 vaccinations. Being in a racial or ethnic minority group. Having common underlying health conditions and behaviors such as physical inactivity, obesity, depression, smoking (former or present), and disabilities. See CDC comprehensive discussion. Older adults, especially those 50 and older, regardless of the presence of a medical condition. For more information, see the CDC webpage Interim Clinical Considerations for COVID-19 Treatment in Outpatients. The following factors should NOT be reasons to withhold COVID-19 treatment: Being fully or partially vaccinated. Having a history of prior SARS-CoV-2 infection. Presence of only mild disease. Patients with mild symptoms are included in criteria for outpatient treatment according to the FDA EUA and NIH recommendations. A lack of recent renal or liver function tests. The FDA EUA does not require assessment of laboratory results. Possible drug-drug interactions. In some situations it may be safe to proceed with treatment, guidance is available on simple steps (such as brief suspension or dose reduction) to avoid significant interactions with commonly prescribed medications. See the California Department of Public Health (CDPH) Advisory Reminder to Lower Barriers to Prescribing COVID-19 Therapeutics to Mitigate Impact of COVID-19 In LA County, providers are encouraged to visit the LAC DPH COVID-19 Therapy for Non-Hospitalized Patients website for useful resources. See the CDC HAN online. To view this and other communications or to sign-up to receive LAHANs, please visit publichealth.lacounty.gov/lahan.