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[BMJ更新指南]:WHO新冠肺炎有关抗病毒药物的更新
2020年11月23日 指南导读, 进展交流 暂无评论

A living WHO guideline on drugs for covid-19

Bram Rochwerg, Thomas Agoritsas, François Lamontagne, et al

BMJ 2020;370:m3379 doi: https://doi.org/10.1136/bmj.m3379 (Published 04 September 2020)

Abstract

Clinical question

What is the role of drug interventions in the treatment of patients with covid-19?

New recommendation

The latest version of this WHO living guidance focuses on remdesivir, following the 15 October 2020 preprint publication of results from the WHO SOLIDARITY trial. It contains a weak or conditional recommendation against the use of remdesivir in hospitalised patients with covid-19

Recommendations

The first version on this living guidance focused on corticosteroids. The strong recommendation for systemic corticosteroids in patients with severe and critical covid-19, and a weak or conditional recommendation against systemic corticosteroids in patients with non-severe covid-19 are unchanged.

How this guideline was created

WHO has partnered with the non-profit Magic Evidence Ecosystem Foundation (MAGIC) for methodologic support, to develop and disseminate living guidance for covid-19 drug treatments, based on a living systematic review and network analysis. An international standing Guideline Development Group (GDG) of content experts, clinicians, patients, and methodologists produced recommendations following standards for trustworthy guideline development using the GRADE approach. No competing interests were identified for any panel member.

Understanding the new recommendation

When moving from evidence to the conditional recommendation against the use of remdesivir in patients with covid-19, the panel emphasised the evidence suggesting no important effect on mortality, need for mechanical ventilation, time to clinical improvement, and other patient-important outcomes. Considering the low or very low certainty evidence for all outcomes, the panel interpreted the evidence as not proving that remdesivir is ineffective; rather, there is no evidence based on currently available data that it does improve patient-important outcomes. The panel placed low value on small and uncertain benefits in the presence of the remaining possibility of important harms. In addition, the panel considered contextual factors such as resources, feasibility, acceptability, and equity for countries and health care systems.

Updates

This is a living guideline. It replaces an earlier version published on 4 September 2020 and the BMJRapid Recommendations on remdesivir published on 2 July 2020, and the previous version can be found as a data supplement. Future updates are planned to cover hydroxychloroquine and lopinavir-rotinavir. New recommendations will be published as updates to this guideline.

Readers note

This version is update 1 of the living guideline (BMJ 2020;370:m3379). When citing this article, please consider adding the update number and date of access for clarity.

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