Current best evidence for clinical care (more info)
BACKGROUND: There are many pharmacologic therapies that are being used or considered for treatment of COVID-19. There is a need for frequently updated practice guidelines on their use, based on critical evaluation of rapidly emerging literature.
OBJECTIVE: Develop evidence-based rapid guidelines intended to support patients, clinicians and other health-care professionals in their decisions about treatment and management of patients with COVID-19.
METHODS: IDSA formed a multidisciplinary guideline panel of infectious disease clinicians, pharmacists, and methodologists with varied areas of expertise. Process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and grey literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations.
RESULTS: The IDSA guideline panel agreed on 7 treatment recommendations and provided narrative summaries of other treatments undergoing evaluations.
CONCLUSIONS: The panel expressed the overarching goal that patients be recruited into ongoing trials, which would provide much needed evidence on the efficacy and safety of various therapies for COVID-19, given that we could not make a determination whether the benefits outweigh harms for most treatments.
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This is a very thorough piece of work with proper methodology resulting in honest recommendations with knowledge gaps identified.
As an internist, I find this information useful as we are exploring the use of existing or repurposed drugs to treat COVID-19. However, since clinical trials were ongoing or were still to be started at the time when the article was written, the recommendations are now dated and thus, are no longer applicable. For example, there is a recommendation not to use corticosteroids, which now has been reversed because of the RECOVERY trial. An update of this guideline based on recent evidence, if available, would be more useful to clinicians.