Pharmacological therapy used in the treatment of COVID-19 in pregnancy

ClassDrugDurationIndicationEvidence base
CorticosteroidPrednisolone 40 mg once daily, or hydrocortisone 80 mg twice daily, or methylprednisolone 1 mg·kg−1 twice daily for 5–7 days followed by once daily for 5–7 daysFor 10 days or until discharge from hospital (individualised in the ICU setting)Oxygen saturation <94% on room air or need for supplemental oxygenSignificant reduction in 28-day mortality [11]
IL-6 receptor antagonistTocilizumab 8 mg·kg−1 or sarilumab 400 mgAdministered once only by intravenous infusionCRP ≥75 mg·L−1 and oxygen requirement or admission to critical careReduction in 60-day mortality; possible reduced progression to intubation [12]
Neutralising monoclonal antibodyCasirivimab and imdevimabPatients hospitalised with COVID-19: 2.4 g as a combined single intravenous infusion
Patients with hospital-onset COVID-19: 1.2 g as a combined single intravenous infusion
Delta variant; SARS-CoV-2 IgG negativeReduction in 28-day mortality in patients admitted to hospital who were seronegative at baseline [13]
Neutralising monoclonal antibodySotrovimab 500 mgAdministered as a single intravenous infusion over 30 minNon-hospitalised patients with mild to moderate disease who are considered very high risk for disease progression [14]Reduces the risk of hospitalisation or death by 70–85% [1, 15]
Neutralising monoclonal antibodyTixagevimab 300 mg i.m. and cilgavimab 300 mg i.m.Administered as separate, consecutive intramuscular injectionsNot routinely given; the MHRA supports its use where the expected benefits outweigh the potential risks [16]Pre-exposure immunoprophylaxis in adults who have an increased risk of an inadequate response to vaccination, increased risk of exposure, or both [16]
AntiviralRemdesivir3-day course i.v.: 200 mg on day 1 and 100 mg on days 2 and 3Not routinely recommended; may be considered in women who are deteriorating despite standard management and have a non-omicron genotypeReduces the risk of hospitalisation or death by 85–90% [17, 18]

ICU: intensive care unit; IL: interleukin; CRP: C-reactive protein; MHRA: Medicines and Healthcare products Regulatory Agency.