A living WHO guideline on drugs for covid-19
Arnav Agarwal et al.
https://doi.org/10.1136/bmj.m3379 PER SCARICARE LA GRAFICA INTERATTIVA
UPDATES This is a living guideline. It replaces earlier versions (4 September 2020, 20 November 2020, 17 December 2020, 31 March 2021, 6 July 2021, and 23 September 2021). The previous versions can be found as data supplements. New recommendations will be published as updates to this guideline. CLINICAL QUESTION What is the role of drugs in the treatment of patients with covid-19? CONTEXT The evidence base for therapeutics for covid-19 is increasing with numerous randomized controlled trials (RCTs) underway. This update includes recommendations on convalescent plasma, informed by pooled data from 16 RCTs with 16,236 patients. NEW RECOMMENDATIONS The Guideline Development Group (GDG) made a strong recommendation against the use of convalescent plasma in patients with non-severe illness, and a recommendation against its use in patients with severe and critical illness, except in the context of an RCT. UNDERSTANDING THE NEW RECOMMENDATIONS When moving from evidence to recommendations against the use of convalescent plasma, the GDG considered a combination of evidence assessing relative benefits and harms, values and preferences, and feasibility issues. The GDG recognised there was no clear benefit for critical outcomes such as mortality and mechanical ventilation for patients with non-severe, severe, or critical illness, and significant resource requirements in terms of cost and time for administration. Thus, the strong recommendation against use reflects the GDG’s view that plasma administration, especially for patients with non-severe illness where there is a low baseline risk of mortality and other important clinical outcomes, is not justified. The GDG believed that, although convalescent plasma should not be used in any severity subgroups as part of routine care, there was sufficient uncertainty in patients with severe and critical illness to warrant continuation of RCTs. PRIOR RECOMMENDATIONS • Recommended for patients with severe and critical covid-19—A strong recommendation for systemic corticosteroids; a strong recommendation for interleukin-6 receptor blockers (tocilizumab or sarilumab); a conditional recommendation for casirivimab and imdevimab, for those having seronegative status. • Recommended for patients with non-severe covid-19—A conditional recommendation for casirivimab and imdevimab, for those at highest risk of severe disease. • Not recommended for patients with non-severe covid-19—A conditional recommendation against systemic corticosteroids. • Not recommended, regardless of covid-19 disease severity—A conditional recommendation against remdesivir; a strong recommendation against hydroxychloroquine; a strong recommendation against lopinavir/ritonavir; a recommendation against ivermectin, except in the context of a clinical trial. ABOUT THIS GUIDELINE This living guideline, from the World Health Organization (WHO), incorporates new recommendations on therapies for covid-19 and provides updates on existing recommendations. The GDG typically evaluates a therapy when WHO judges sufficient evidence is available to make a recommendation. While the GDG takes an individual-patient perspective in making recommendations, it also considers resource implications, acceptability, feasibility, equity, and human rights. This guideline was developed according to standards and methods for trustworthy guidelines. MAGIC Evidence Ecosystem Foundation provides methodological support, including the coordination of living systematic reviews with network meta-analysis to inform the recommendations.
LEGGI TUTTO https://doi.org/10.1136/bmj.m3379