2025 Clinical Practice Guideline Update by the Infectious Diseases Society of America on the Treatment and Management of COVID-19: Baricitinib vs. Tocilizumab

Abstract This article provides a focused update to the clinical practice guideline on the treatment and management of patients with COVID-19, developed by the Infectious Diseases Society of America. The guideline panel presents a new recommendation on the use of baricitinib vs. tocilizumab in hospitalized adults with severe or critical COVID-19. The panel has previously issued recommendations on baricitinib vs. no baricitinib and tocilizumab vs. no tocilizumab, but this new recommendation compares baricitinib to tocilizumab when the decision has been made to give one or the other. The new recommendation does not address combinations of multiple immunomodulatory agents (ie, baricitinib, tocilizumab, abatacept, infliximab). The recommendation is based on evidence derived from a systematic literature review and adheres to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.