Management of COVID-19 in Immunocompromised Patients: An ESCMID Consensus Document.

Abstract

Introduction: Data on treatment of COVID-19 in immunocompromised patients emerged recently ; however, published guidelines for management of COVID-19 in immunocompromised patients are lacking.

Aim and methods: To develop consensus statements derived from evidence and expert opinion on management of COVID-19 in immunocompromised patients an expert panel was convened by ESCMID. The expert panel developed a list of questions which are of general interest for clinicians and readers with backgrounds in clinical microbiology and infectious diseases. Six questions were selected. For each question, systematic literature searches were undertaken. We considered most study types, including clinical trials, observational studies with or without a control group, systematic reviews, case series, and case reports. Detailed inclusion criteria were defined for each research question using the Population Intervention Comparison Outcome format. Immunocompromised patients included patients with 1) primary immune deficiencies; 2) active malignancy or malignancy diagnosed or received cancer therapies within 1 year of COVID-19 diagnosis, 3) HIV with a CD4+ T-lymphocyte count < 200 cells/mm3 or percentage < 14%; 4) receipt of solid organ transplant (SOT) within 1 year of COVID-19 diagnosis; 5) receipt of hematopoietic cell transplant (HCT) or chimeric antigen receptor T-cell therapy within 1 year of COVID-19 diagnosis; 6) receipt of systemic corticosteroid therapy with a dose of ≥ 20 mg prednisone or equivalent daily for ≥ 14 days or a cumulative dose of > 600 mg of prednisone; 7) receipt of biological immune modulators; or 8) receipt of disease-modifying antirheumatic drugs or other immunosuppressive drugs. The panel's consensus statements were based on evidence, supplemented by experience and expert opinion, especially in cases when evidence was limited or scarce. This document is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standard.