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APRIL 16, 2020 --There is currently insufficient evidence to recommend any particular medication for treatment of COVID-19, an expert panel of the Infectious Diseases Society of America (IDSA) has concluded.
Many pharmacologic therapies are being used or considered for the treatment of patients with COVID-19. Given the rapidly emerging literature on treatment, the IDSA convened the panel to develop interim evidence-based guidelines to support clinicians in making decisions about treatment and management of patients with COVID-19.
This is a "living document" that represents the best understanding to date on the treatment of patients with COVID-19, and it will be updated frequently as new information becomes available, IDSA member Rajesh Gandhi, MD, from Harvard Medical School and the Massachusetts General Hospital, Boston, said today during a media briefing.
Adarsh Bhimraj, MD, associate staff physician, Department of Infectious Diseases, Cleveland Clinic, Ohio, chaired the IDSA COVID-19 rapid guidelines expert panel. He urged caution in using unproven agents.
"Over the last few weeks, in caring for these patients, we have used therapeutic agents which were not proven, and some of these patients had adverse reactions, and as a team, we wondered, are we actually helping these patients, or could we be potentially harming these patients by using these medications?," he told the briefing.
On the subject of hydroxychloroquine, Bhimraj acknowledged that it's "frustrating not to do anything when people are suffering, but [the panel] objectively looked at all the data, and we all individually were able to conclude that at this point in time, the benefits do not outweigh the harms, so we cannot recommend the routine use of this medication."
Recommendations and Narrative Summaries
Following a rigorous review and data synthesis, the panel agreed on seven treatment recommendations. They note that in their recommendations, the word "recommend" indicates strong recommendations, and the word "suggest" indicates conditional recommendations. In their recommendations about drugs, the guideline panel used the word "only" when there was "higher uncertainty and/or more potential for harm."
They also used the phrase "knowledge gap" to accentuate their statements on the seven recommendations.
Among patients who have been admitted to the hospital with COVID-19, the IDSA guideline panel recommends hydroxychloroquine/chloroquine plus azithromycin only in the context of a clinical trial. (Knowledge gap)
Among patients who have been admitted to the hospital with COVID-19, the IDSA guideline panel recommends the combination of lopinavir/ritonavir only in the context of a clinical trial. (Knowledge gap)
Among patients who have been admitted to the hospital with acute respiratory distress syndrome associated with COVID-19, the IDSA guideline panel recommends the use of corticosteroids in the context of a clinical trial. (Knowledge gap)
Among patients who have been admitted to the hospital with COVID-19, the IDSA guideline panel recommends tocilizumab only in the context of a clinical trial. (Knowledge gap)
Among patients who have been admitted to the hospital with COVID-19, the IDSA guideline panel recommends COVID-19 convalescent plasma in the context of a clinical trial. (Knowledge gap)
The document also includes "narrative summaries" of other treatments currently undergoing evaluation and for which more data are needed to formulate recommendations.
These treatments are the following: HIV antivirals, lopinavir-ritonavir combined with interferon beta or other antivirals; COVID-19 convalescent plasma for prophylaxis; ribavirin; oseltamivir; intravenous immunoglobulin; remdesivir; stopping nonsteroidal anti-inflammatory drugs or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy for COVID-19 patients.
Guided by Science, 100+ Clinical Trials Underway
The guidelines further state that "when an explicit trade-off between the highly uncertain benefits and the known putative harms of these therapeutic agents were considered, a net positive benefit was not reached and could possibly be negative (risk of excess harm)."
"The only way to find a treatment for COVID-19 is to do the clinical trials. We really need to be guided by the science," Gandhi told the briefing. He said that more than 100 clinical trials are currently underway in the United States, and around the world, many more trials are investigating treatment options. "Some of these trials we think will have results in the next few weeks," he said.
The IDSA plans to issue COVID-19 guidelines on diagnostic testing and infection prevention in healthcare settings.
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