Pharmacological therapy used in the treatment of COVID-19 in pregnancy
| Class | Drug | Duration | Indication | Evidence base |
| Corticosteroid | Prednisolone 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 days | For 10 days or until discharge from hospital (individualised in the ICU setting) | Oxygen saturation <94% on room air or need for supplemental oxygen | Significant reduction in 28-day mortality [11] |
| IL-6 receptor antagonist | Tocilizumab 8 mg·kg−1 or sarilumab 400 mg | Administered once only by intravenous infusion | CRP ≥75 mg·L−1 and oxygen requirement or admission to critical care | Reduction in 60-day mortality; possible reduced progression to intubation [12] |
| Neutralising monoclonal antibody | Casirivimab and imdevimab | Patients 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 negative | Reduction in 28-day mortality in patients admitted to hospital who were seronegative at baseline [13] |
| Neutralising monoclonal antibody | Sotrovimab 500 mg | Administered as a single intravenous infusion over 30 min | Non-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 antibody | Tixagevimab 300 mg i.m. and cilgavimab 300 mg i.m. | Administered as separate, consecutive intramuscular injections | Not 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] |
| Antiviral | Remdesivir | 3-day course i.v.: 200 mg on day 1 and 100 mg on days 2 and 3 | Not routinely recommended; may be considered in women who are deteriorating despite standard management and have a non-omicron genotype | Reduces 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.