COVID-19 treatment guidelines: IDSA scrutinizes experimental agents

  • Bhimraj A & al.
  • Clin Infect Dis
  • 27 abr. 2020

  • de Liz Scherer
  • Clinical Essentials
El acceso al contenido completo es sólo para profesionales sanitarios registrados. El acceso al contenido completo es sólo para profesionales sanitarios registrados.

Takeaway

  • COVID-19 treatment guidelines from the Infectious Disease Society of America (IDSA) reinforce the lack of strong evidence for unproven agents in the hospital setting.
  • Agents are recommended only in the context of a clinical trial.

Why this matters

  • Clinicians should consider tradeoffs between highly uncertain benefits for hospitalized patients with COVID-19 and known putative harms.

Key points

  • With hydroxychloroquine/chloroquine alone or plus azithromycin (very low evidence):
    • Clinical progression on radiology:
      • Risk ratio (RR): 0.61 (95% CI, 0.26-1.43). 
    • Viral clearance by RT-PCR:
      • RR: 2.00 (95% CI, 0.02-20.00). 
    • Adverse events (AEs) include significant QT prolongation, QT increase >500 milliseconds or discontinuation.
  • Lopinavir/ritonavir (very low evidence): 
    • Modified intention-to-treat, mortality: RR, 0.67 (95% CI, 0.38-1.17).
    • ~14% of recipients failed to complete trials because of AEs.
  • Corticosteroids for hospitalized patients with acute respiratory distress syndrome or COVID-19 pneumonia (very low evidence): data limitations prevent sensible pooling of potential treatments.
    • Continue inhaled/systemic agents for other indications.
  • Tocilizumab (very low evidence): high bias risk precludes definitive conclusions.
    • Potential AEs: serious infections, hepatitis B reactivation, anaphylaxis, severe liver damage, hepatic failure. 
  • Convalescent plasma (very low evidence): high bias risk, imprecision; no deaths or serious AEs reported.
  • Consult guidelines for treatments under evaluation.