2025 Clinical Practice Guideline Update by the Infectious Diseases Society of America on the Treatment and Management of COVID-19: Pemivibart for Pre-exposure Prophylaxis, Vilobelimab for Critical Illness, and Abatacept or Infliximab for Severe or Critical Illness

Adarsh Bhimraj¹, Yngve Falck-Ytter^{2

3}, Lindsey R Baden^{4

5}, Roger Bedimo⁶, Kelly Cawcutt⁷, Vincent Chi-Chung Cheng⁸, Kara W Chew⁹, Kathleen Chiotos¹⁰, Eric S Daar¹¹, Amy L Dzierba¹², David V Glidden¹³, Erica J Hardy¹⁴, Steven Johnson¹⁵, Arthur Y Kim^{4

16}, Jonathan Z Li^{4

5}, Christine MacBrayne¹⁷, Greg S Martin¹⁸, Nandita Nadig¹⁹, Mari M Nakamura^{20

21}, Jeffrey C Pearson²², Laura Riley^{23

24}, Robert W Shafer²⁵, Shmuel Shoham²⁶, Amy Hirsch Shumaker^{2

3}, Pablo Tebas²⁷, Phyllis C Tien²⁸, Jennifer Loveless²⁹, Rebecca L Morgan^{2

30}, Rajesh T Gandhi^{4

16}

Affiliations

¹ Division of Infectious Diseases, Houston Methodist Hospital, Houston, Texas, USA.
² Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA.
³ Department of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA.
⁴ Harvard Medical School, Boston, Massachusetts, USA.
⁵ Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁶ Department of Medicine, UT Southwestern/VA North Texas Health Care System, Dallas, Texas, USA.
⁷ Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA.
⁸ Department of Microbiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.
⁹ Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA.
¹⁰ Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia/University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹¹ Department of Medicine, Harbor-UCLA Medical Center, Torrance, California, USA.
¹² Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA.
¹³ Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
¹⁴ Departments of Medicine and Obstetrics and Gynecology, Brown University, Providence, Rhode Island, USA.
¹⁵ Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
¹⁶ Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
¹⁷ Department of Pharmacy, Children's Hospital Colorado, Aurora, Colorado, USA.
¹⁸ Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, Georgia, USA.
¹⁹ Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
²⁰ Antimicrobial Stewardship Program and Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA.
²¹ Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
²² Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts, USA.
²³ New York-Presbyterian Hospital/Weill Cornell Medical Center, New York City, New York, USA.
²⁴ Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York City, New York, USA.
²⁵ Department of Medicine, Stanford University, Palo Alto, California, USA.
²⁶ Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
²⁷ Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
²⁸ Department of Medicine, UCSF/VA San Francisco Health Care System, San Francisco, California, USA.
²⁹ Clinical Affairs and Practice Guidelines, Infectious Diseases Society of America, Arlington, Virginia, USA.
³⁰ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.

PMID: 40757658
PMCID: PMC12809781 (available on 2026-08-04)
DOI: 10.1093/cid/ciaf424

Practice Guideline

2025 Clinical Practice Guideline Update by the Infectious Diseases Society of America on the Treatment and Management of COVID-19: Pemivibart for Pre-exposure Prophylaxis, Vilobelimab for Critical Illness, and Abatacept or Infliximab for Severe or Critical Illness

Adarsh Bhimraj et al. Clin Infect Dis. 2026.

. 2026 Jan 16;81(Supplement_3):i1-i5.

doi: 10.1093/cid/ciaf424.

Authors

Affiliations

¹ Division of Infectious Diseases, Houston Methodist Hospital, Houston, Texas, USA.
² Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, Ohio, USA.
³ Department of Medicine, VA Northeast Ohio Healthcare System, Cleveland, Ohio, USA.
⁴ Harvard Medical School, Boston, Massachusetts, USA.
⁵ Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁶ Department of Medicine, UT Southwestern/VA North Texas Health Care System, Dallas, Texas, USA.
⁷ Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA.
⁸ Department of Microbiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China.
⁹ Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA.
¹⁰ Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia/University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹¹ Department of Medicine, Harbor-UCLA Medical Center, Torrance, California, USA.
¹² Department of Medicine, New York University Grossman School of Medicine, New York City, New York, USA.
¹³ Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA.
¹⁴ Departments of Medicine and Obstetrics and Gynecology, Brown University, Providence, Rhode Island, USA.
¹⁵ Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
¹⁶ Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
¹⁷ Department of Pharmacy, Children's Hospital Colorado, Aurora, Colorado, USA.
¹⁸ Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, Georgia, USA.
¹⁹ Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
²⁰ Antimicrobial Stewardship Program and Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA.
²¹ Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
²² Department of Pharmacy, Brigham and Women's Hospital, Boston, Massachusetts, USA.
²³ New York-Presbyterian Hospital/Weill Cornell Medical Center, New York City, New York, USA.
²⁴ Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York City, New York, USA.
²⁵ Department of Medicine, Stanford University, Palo Alto, California, USA.
²⁶ Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
²⁷ Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
²⁸ Department of Medicine, UCSF/VA San Francisco Health Care System, San Francisco, California, USA.
²⁹ Clinical Affairs and Practice Guidelines, Infectious Diseases Society of America, Arlington, Virginia, USA.
³⁰ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.

PMID: 40757658
PMCID: PMC12809781 (available on 2026-08-04)
DOI: 10.1093/cid/ciaf424

Abstract

As the first part of several focused updates to the clinical practice guideline on the treatment and management of COVID-19 in adults, children, and pregnant people, developed by the Infectious Diseases Society of America, the panel presents four new recommendations. These recommendations include pre-exposure prophylaxis for immunocompromised persons and treatment of severe or critical COVID-19. The panel's recommendations are based upon evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

Keywords: COVID-19; abatacept; infliximab; pemivibart; vilobelimab.

© The Author(s) 2025. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

PubMed Disclaimer

Conflict of interest statement

Potential conflicts of interest. Evaluation of relationships as potential conflicts of interest is determined by a review process. The assessment of disclosed relationships for possible COIs is based on the relative weight of the financial relationship (ie, monetary amount) and the relevance of the relationship (ie, the degree to which an association might reasonably be interpreted by an independent observer as related to the topic or recommendation of consideration). No panelists had COIs directly related to pemivibart, abatacept, or infliximab. The following panelists have scientific advisory/consultant roles not related to the topic of COVID-19 with indicated companies: R. B. with Shionogi, Merck, and Gilead, E. S. D. with Gilead, D. V. G. with Merck and Gilead, S. S. with Pfizer (concluded), P. T. with Merck, and R. T. G. with Merck. The following panelists have scientific advisory/consultant roles related to COVID-19 but not severe/critical COVID-19 with indicated companies: R. B. with Shionogi, K. W. C. with Pardes Biosciences (concluded), A. Y. K. with Shionogi, S. S. with Adamis and Immunome (concluded), and P. T. with Shionogi. J. C. P. had a scientific advisory/consultant role (concluded) with InflaRx related to vilobelimab for critical COVID-19. His participation was carefully managed during discussions, and he recused himself from all voting on vilobelimab. No disclosures were reported for all other authors (the majority of panelists), including the chair and vice chair.

References

1. Bhimraj A, Morgan RL, Shumaker AH, et al. Infectious Diseases Society of America guidelines on the treatment and management of patients with COVID-19 (September 2022). Clin Infect Dis 2024; 78:e250–349. - PMC - PubMed
1. Bhimraj A, Falck-Ytter Y, Kim AY, et al. 2024 Clinical practice guideline update by the Infectious Diseases Society of America on the management of COVID-19: anti-SARS-CoV-2 neutralizing antibody pemivibart for pre-exposure prophylaxis. Clin Infect Dis 2025; 81:i6–12. - PubMed
1. Nadig N, Bhimraj A, Cawcutt K, et al. 2025 Clinical practice guideline update by the Infectious Diseases Society of America on the treatment and management of COVID-19: abatacept. Clin Infect Dis 2025; 81:i17–21. - PubMed
1. Nadig N, Bhimraj A, Cawcutt K, et al. 2025 Clinical practice guideline update by the Infectious Diseases Society of America on the treatment and management of COVID-19: infliximab. Clin Infect Dis 2025; 81:i22–6. - PMC - PubMed
1. Nadig N, Bhimraj A, Cawcutt K, et al. 2025 Clinical practice guideline update by the Infectious Diseases Society of America on the treatment and management of COVID-19: vilobelimab. Clin Infect Dis 2025; 81:i13–6. - PMC - PubMed

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2025 Clinical Practice Guideline Update by the Infectious Diseases Society of America on the Treatment and Management of COVID-19: Pemivibart for Pre-exposure Prophylaxis, Vilobelimab for Critical Illness, and Abatacept or Infliximab for Severe or Critical Illness

Affiliations

2025 Clinical Practice Guideline Update by the Infectious Diseases Society of America on the Treatment and Management of COVID-19: Pemivibart for Pre-exposure Prophylaxis, Vilobelimab for Critical Illness, and Abatacept or Infliximab for Severe or Critical Illness

Authors

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Conflict of interest statement

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