COVID-19: WHO recommends against remdesivir, for systemic corticosteroids

  • Lamontagne F & al.
  • BMJ
  • 4 sept. 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

  • WHO recommends against remdesivir for patients hospitalized with severe COVID-19.
  • The panel formulating recommendations for this living guideline sees no "important effect" in terms of mortality, need for/duration of mechanical ventilation, or time to clinical improvement.
  • A strong recommendation still stands for systemic corticosteroids for severe/critical COVID-19 and against them for nonsevere disease.

Why this matters

  • The panel notes low/very low certainty evidence for all outcomes and that it does not interpret the evidence as proving that remdesivir is ineffective.
  • See guideline for summary of available data.

Key points

  • Systemic corticosteroids (200 mg day 1, 100 mg days 5-10) are strongly recommended for treatment of patients with severe, critical COVID-19, even if they are not hospitalized or on oxygen because of limited resources.
    • Caution is warranted with corticosteroids in patients with diabetes or tuberculosis, in those who are immunocompromised, or in children.
  • Do not use corticosteroids in patients with nonsevere disease regardless of hospitalization status.
  • Continue treatment in patients taking them for other conditions.
    • Consider systemic corticosteroids if patients worsen.
  • For pregnant women with no evidence of infection who are at risk for preterm birth, administer antenatal corticosteroid therapy at weeks 24-34 gestation.

Study design

  • WHO living guideline on use of remdesivir in patients with severe COVID-19.
  • Funding: No specific funding.

Limitations

  • Evolving data.
  • Uncertainties persist around outcomes.