A living WHO guideline on drugs for covid-19

A living WHO guideline on drugs for covid-19

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 BMJ Rapid 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.

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