Therapeutics and Covid-19 – Living guideline
In the latest update of this WHO living guideline, which follows the preprint publication of results from the SOLIDARITY trial, the panel makes a conditional recommendation against the use of remdesivir in hospitalised patients with COVID-19, regardless of disease severity.
Source:
World Health Organization
SPS commentary:
The recommendation on remdesivir was based on results from a systematic review and network meta-analysis (4RCTs; n=7333), which suggested remdesivir had possibly no effect on mortality (absolute effect estimate 10 fewer deaths per 1000 patients, 95% CI from 29 fewer - 11 more deaths per 1000 patients; low certainty evidence); and possibly no effect on the other important outcomes.
This guidance adds to recommendations published in the previous version: a strong recommendation for systemic corticosteroids in patients with severe and critical COVID19, and a conditional recommendation against systemic corticosteroids in patients with non-severe COVID-19.
The SOLIDARITY trial also reported results on hydroxychloroquine and lopinavir-ritonavir, and recommendations for these are due to follow.
The results of this living review have been summarised in an updated BMJ Rapid Recommendations article. A Feature report in the BMJ discusses the story of remdesivir so far and whether it is ‘the next Tamiflu’.
According to a Reuters report, the European Commission has said there has been no change in the authorised use of remdesivir. The European Medicines Agency has requested full data on remdesivir from the SOLIDARITY trial and will assess the evidence, together with other available data, to see if any changes are required to its market authorisation.