IDSA publishes ‘living guidelines’ on treatment of COVID-19
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The Infectious Diseases Society of America published rapid guidelines on the treatment and management of patients with COVID-19 that mostly recommend recruiting patients into ongoing trials for investigational therapies.
The guidelines were developed by a panel of nine frontline clinicians and infectious disease specialists and focus mainly on patients hospitalized with COVID-19 with moderate or severe disease. They are based on the latest available evidence and will be updated as more information becomes available, said Adarsh Bhimraj, MD, chair of the IDSA’s COVID-19 rapid guidelines expert panel and associate staff physician in the department of infectious diseases at Cleveland Clinic.
“The recommendations take into consideration outcomes that matter for patients. Do these medications prevent death? Do these medications actually alleviate the suffering of patients?” Bhimraj said during a press briefing.
“These are living guidelines,” he said. “When new data emerge, we will be prompt and we will update [the guidance].”
According to Rajesh T. Gandhi, MD, professor of medicine at Harvard Medical School and director of HIV clinical services and education at Massachusetts General Hospital, there are more than 100 clinical trials underway in the United States — and many more in other countries — that are evaluating treatment options for COVID-19. Some may produce results in “the next few weeks,” he said.
Experts are hopeful that early results from ongoing trials evaluating the investigational antiviral remdesivir (Gilead Sciences), which was developed as a therapy for Ebola, will be available by the end of April.
“The message of the guidelines is that we need to do clinical trials and clinical studies. We firmly believe that this is the only way to make advances and find a treatment for COVID-19,” Gandhi said. “We need to know more in a month from now than we do now, and we need to know more in 3 months than we do in 1 month. We really need to be guided by the science.”
Most of the guidelines recommend using therapeutic agents in the context of a clinical trial. In several instances, the panel added the word “only” to the recommendation when there was less certainty that a therapeutic intervention or medication is effective or more of a concern over possible harm.
For clinicians who experience trouble enrolling patients in a clinical trial, Bhimraj recommended setting up a hospital registry and asking other hospitals to collaborate.
“What we do today in the context of the COVID-19 pandemic has implications for the next pandemic and the pandemic after that. We all can contribute to the science in a little way,” he said. “I think that our patient care decisions should be based in the science and evidence and I’m hoping in the next couple of weeks we’ll find some evidence to suggest whether these medications work or not.”
The recommendations as summarized by the IDSA are as follows:
Recommendation 1. Among patients who have been admitted to the hospital with COVID-19, the IDSA guideline panel recommends hydroxychloroquine/chloroquine in the context of a clinical trial. (Knowledge gap)
Recommendation 2. 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)
Recommendation 3. 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)
Recommendation 4. Among patients who have been admitted to the hospital with COVID-19 pneumonia, the IDSA guideline panel suggests against the use of corticosteroids. (Conditional recommendation, very low certainty of evidence)
Recommendation 5. Among patients who have been admitted to the hospital with acute respiratory distress syndrome due to COVID-19, the IDSA guideline panel recommends the use of corticosteroids in the context of a clinical trial. (Knowledge gap)
Recommendation 6. 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)
Recommendation 7. 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 panel also will publish guidelines on diagnostics and infection prevention. Those documents are expected soon. – by Gerard Gallagher
Reference:
Bhimraj A, et al. Infectious Diseases Society of America Guidelines on the treatment and management of patients with COVID-19. https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/. Accessed April 14, 2020.
Disclosures: Please see the guidelines for an explanation on the disclosure and management of potential conflicts.
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Bhimraj A, et al. Infectious Diseases Society of America Guidelines on the treatment and management of patients with COVID-19. https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/. Accessed April 14, 2020.
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