RT Journal Article
SR Electronic
T1 A living WHO guideline on drugs for covid-19
JF BMJ
JO BMJ
FD British Medical Journal Publishing Group
SP m3379
DO 10.1136/bmj.m3379
VO 370
A1 Agarwal, Arnav
A1 Hunt, Beverley J
A1 Stegemann, Miriam
A1 Rochwerg, Bram
A1 Lamontagne, François
A1 Siemieniuk, Reed AC
A1 Agoritsas, Thomas
A1 Askie, Lisa
A1 Lytvyn, Lyubov
A1 Leo, Yee-Sin
A1 Macdonald, Helen
A1 Zeng, Linan
A1 Alhadyan, Ahmed
A1 Muna, Al-Maslamani
A1 Amin, Wagdy
A1 da Silva, André Ricardo Araujo
A1 Aryal, Diptesh
A1 Barragan, Fabian A Jaimes
A1 Bausch, Frederique J
A1 Burhan, Erlina
A1 Calfee, Carolyn S
A1 Cecconi, Maurizio
A1 Chacko, Binila
A1 Chanda, Duncan
A1 Dat, Vu Quoc
A1 De Sutter, An
A1 Du, Bin
A1 Freedman, Stephen
A1 Geduld, Heike
A1 Gee, Patrick
A1 Haider, Muhammad
A1 Gotte, Matthias
A1 Harley, Nerina
A1 Hashmi, Madiha
A1 Hui, David
A1 Ismail, Mohamed
A1 Jehan, Fyezah
A1 Kabra, Sushil K
A1 Kanda, Seema
A1 Kim, Yae-Jean
A1 Kissoo, Niranjan
A1 Krishna, Sanjeev
A1 Kuppalli, Krutika
A1 Kwizera, Arthur
A1 Castro-Rial, Marta Lado
A1 Lisboa, Thiago
A1 Lodha, Rakesh
A1 Mahaka, Imelda
A1 Manai, Hela
A1 Mendelson, Marc
A1 Battista Migliori, Giovanni
A1 Mino, Greta
A1 Nsutebu, Emmanuel
A1 Peter, Jessica
A1 Preller, Jacobus
A1 Pshenichnaya, Natalia
A1 Qadir, Nida
A1 Ranganathan, Shalini S
A1 Relan, Pryanka
A1 Rylance, Jamie
A1 Sabzwari, Saniya
A1 Sarin, Rohit
A1 Shankar-Hari, Manu
A1 Sharland, Michael
A1 Shen, Yinzhong
A1 Souza, Joao P
A1 Swanstrom, Ronald
A1 Tshokey, Tshokey
A1 Ugarte, Sebastian
A1 Uyeki, Timothy
A1 Vazquez Curiel, Evangelina
A1 Venkatapuram, Sridhar
A1 Vuyiseka, Dubula
A1 Wijewickrama, Ananda
A1 Tran, Lien
A1 Zeraatkar, Dena
A1 Bartoszko, Jessica J
A1 Ge, Long
A1 Brignardello-Petersen, Romina
A1 Owen, Andrew
A1 Guyatt, Gordon
A1 Diaz, Janet
A1 Kawano-Dourado, Leticia
A1 Jacobs, Michael
A1 Vandvik, Per Olav
YR 2020
UL https://www.bmj.com/content/370/bmj.m3379.abstract
AB Updates This is the fourteenth version (thirteenth update) of the living guideline, replacing earlier versions (available 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 evolving with numerous randomised controlled trials (RCTs) recently completed and underway. Emerging SARS-CoV-2 variants and subvariants are changing the role of therapeutics.What is new?The guideline development group (GDG) defined 1.5% as a new threshold for an important reduction in risk of hospitalisation in patients with non-severe covid-19. Combined with updated baseline risk estimates, this resulted in stratification into patients at low, moderate, and high risk for hospitalisation. New recommendations were added for moderate risk of hospitalisation for nirmatrelvir/ritonavir, and for moderate and low risk of hospitalisation for molnupiravir and remdesivir. New pharmacokinetic evidence was included for nirmatrelvir/ritonavir and molnupiravir, supporting existing recommendations for patients at high risk of hospitalisation. The recommendation for ivermectin in patients with non-severe illness was updated in light of additional trial evidence which reduced the high degree of uncertainty informing previous guidance. A new recommendation was made against the antiviral agent VV116 for patients with non-severe and with severe or critical illness outside of randomised clinical trials based on one RCT comparing the drug with nirmatrelvir/ritonavir. The structure of the guideline publication has also been changed; recommendations are now ordered by severity of covid-19.About this guideline This living guideline from the World Health Organization (WHO) incorporates new evidence to dynamically update recommendations for covid-19 therapeutics. The GDG typically evaluates a therapy when the 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, making use of an innovative process to achieve efficiency in dynamic updating of recommendations. The methods are aligned with the WHO Handbook for Guideline Development and according to a pre-approved protocol (planning proposal) by the Guideline Review Committee (GRC). A box at the end of the article outlines key methodological aspects of the guideline process. MAGIC Evidence Ecosystem Foundation provides methodological support, including the coordination of living systematic reviews with network meta-analyses to inform the recommendations. The full version of the guideline is available online in MAGICapp and in PDF on the WHO website, with a summary version here in The BMJ. These formats should facilitate adaptation, which is strongly encouraged by WHO to contextualise recommendations in a healthcare system to maximise impact.Future recommendations Recommendations on anticoagulation are planned for the next update to this guideline. Updated data regarding systemic corticosteroids, azithromycin, favipiravir and umefenovir for non-severe illness, and convalescent plasma and statin therapy for severe or critical illness, are planned for review in upcoming guideline iterations.