Several antiviral agents are being evaluated for the treatment of COVID-19, but with minimal or no information on safety in pregnancy.
- Remdesivir, an intravenous preparation that has been used in people hospitalised for COVID-19, has been shown to improve time to recovery with a likely benefit on mortality (Bansal et al. 2020, Beigel et al. 2020, Wang et al. 2020). The National COVID-19 Clinical Evidence Taskforce (NCET) does conditionally recommend remdesivir in pregnant women with COVID-19 who require oxygen, but not if they require ventilation. It is likely to be excreted in breast milk.
- The oral antiviral agent nirmaltrevir/ritonavir has demonstrated efficacy in early COVID-19, in unvaccinated people, but there is no safety data in pregnancy.
- Molnupirivir has also demonstrated efficacy in early COVID-19 in unvaccinated people. Molnupiravir was harmful in studies of pregnant animals and it is not recommended for pregnant or breastfeeding women (Sidebottom et al. 2021) .
- Sotrovimab: NCET conditionally recommends for sotrovimab within 5 days of symptom onset in pregnant women with risk factors for severe disease. However, sotrovimab may potentially have reduced efficacy against Omicron variants BA.2, BA.4, BA.5. Evushald (Tixagevimab plus cilgavimab) does have activity against BA.2, but is not currently recommended in pregnancy due to a lack of safety data.
For the latest Australia evidence-based Covid-19 treatment guidelines, visit the National Covid-19 Clinical Evidence Taskforce website