Abstract
PurposeThis executive summary of a national living guideline aims to provide rapid evidence based recommendations on the role of drug interventions in the treatment of hospitalized patients with COVID-19.MethodsThe guideline makes use of a systematic assessment and decision process using an evidence to decision framework (GRADE) as recommended standard WHO (2021). Recommendations are consented by an interdisciplinary panel. Evidence analysis and interpretation is supported by the CEOsys project providing extensive literature searches and living (meta-) analyses. For this executive summary, selected key recommendations on drug therapy are presented including the quality of the evidence and rationale for the level of recommendation.ResultsThe guideline contains 11 key recommendations for COVID-19 drug therapy, eight of which are based on systematic review and/or meta-analysis, while three recommendations represent consensus expert opinion. Based on current evidence, the panel makes strong recommendations for corticosteroids (WHO scale 5–9) and prophylactic anticoagulation (all hospitalized patients with COVID-19) as standard of care. Intensified anticoagulation may be considered for patients with additional risk factors for venous thromboembolisms (VTE) and a low bleeding risk. The IL-6 antagonist tocilizumab may be added in case of high supplemental oxygen requirement and progressive disease (WHO scale 5–6). Treatment with nMABs may be considered for selected inpatients with an early SARS-CoV-2 infection that are not hospitalized for COVID-19. Convalescent plasma, azithromycin, ivermectin or vitamin D3 should not be used in COVID-19 routine care.ConclusionFor COVID-19 drug therapy, there are several options that are sufficiently supported by evidence. The living guidance will be updated as new evidence emerges.
Highlights
The ongoing COVID-19 pandemic causes an enormous pace and volume of research output of varying quality and reliability which is challenging for clinical decision making
For hospitalized patients with COVID-19 moderated by the Association of the Scientific Medical Societies in Germany (AWMF) in collaboration with the COVID-19 Evidence Ecosystem Project (CEOsys)
Evidence profiles of treatment strategies provided by CEOsys form the basis for a structured decision process using the GRADE (Grading of recommendations assessment, development and evaluation) Evidence to Decision Framework [2] with predefined outcomes in compliance with the World Health Organization (WHO) Handbook for Guideline Development [1]
Summary
The ongoing COVID-19 pandemic causes an enormous pace and volume of research output of varying quality and reliability which is challenging for clinical decision making. To provide a clinical treatment guideline that includes a profound evaluation of rapidly changing evidence, the scientific medical societies conduct a living treatment guideline. For hospitalized patients with COVID-19 moderated by the Association of the Scientific Medical Societies in Germany (AWMF) in collaboration with the COVID-19 Evidence Ecosystem Project (CEOsys). CEOsys is an association of 20 German university hospitals whose goal is to compile, summarize, and assess the quality of study results within a structured approach and meta-analysis. Evidence profiles of treatment strategies provided by CEOsys form the basis for a structured decision process using the GRADE (Grading of recommendations assessment, development and evaluation) Evidence to Decision Framework [2] with predefined outcomes in compliance with the WHO Handbook for Guideline Development [1]. The following assessments are subject to constant evaluation and will be re-evaluated, revised or supplemented at short intervals
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