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Japanese rapid/living recommendations on drug management for COVID-19: updated guidelines (September 2021)
Kazuma Yamakawa1, Ryo Yamamoto2, Takero Terayama3
1Department of Emergency Medicine Osaka Medical and Pharmaceutical University Takatsuki Japan.
Insights
This study provides updated recommendations for managing coronavirus disease 2019 (COVID-19) drug treatments. Corticosteroids and anticoagulants are recommended for hospitalized patients, while favipiravir is not suggested for all cases.
Area of Science:
- Infectious Diseases
- Pharmacology
- Clinical Medicine
Background:
- The global COVID-19 pandemic necessitates ongoing updates to clinical management strategies.
- The Japanese Clinical Practice Guidelines for the Management of Sepsis and Septic Shock (J-SSCG) committee developed rapid recommendations for COVID-19 drug therapy.
Purpose of the Study:
- To provide updated, evidence-based clinical practice guidelines for the drug management of COVID-19.
- To guide healthcare professionals in selecting appropriate pharmacotherapies for various COVID-19 severity levels.
Main Methods:
- Utilized the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach for evidence assessment and recommendation strength.
- Reviewed clinical questions (CQs) for specific drugs including favipiravir, remdesivir, corticosteroids, tocilizumab, anticoagulants, baricitinib, and casirivimab/imdevimab.
- This document represents the revised edition (version 4.0) of the guidelines, updated as of September 9, 2021.
Main Results:
- Favipiravir is not recommended for all COVID-19 patients.
- Remdesivir and tocilizumab are suggested for moderate COVID-19 requiring supplemental oxygen.
- Corticosteroids are recommended for moderate to severe COVID-19 but not for mild cases without oxygen requirement.
Conclusions:
- Corticosteroids are strongly recommended for hospitalized COVID-19 patients requiring oxygen or mechanical ventilation.
- Anticoagulants are recommended for moderate to severe COVID-19 requiring hospitalization or intensive care.
- Specific antiviral and immunomodulatory agents have conditional recommendations based on disease severity and oxygen requirements.
Background:
The coronavirus disease 2019 (COVID-19) has spread worldwide since early 2020, and there are still no signs of resolution. The Japanese Clinical Practice Guidelines for the Management of Sepsis and Septic Shock (J-SSCG) 2020 Special Committee created the Japanese rapid/living recommendations on drug management for COVID-19 using the experience of creating the J-SSCG.
Methods:
The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to determine the certainty of the evidence and strength of the recommendations. The first edition of this guideline was released on September 9, 2020, and this document is the revised edition (version 4.0; released on September 9, 2021). Clinical questions (CQs) were set for the following seven drugs: favipiravir (CQ1), remdesivir (CQ2), corticosteroids (CQ4), tocilizumab (CQ5), anticoagulants (CQ7), baricitinib (CQ8), and casirivimab/imdevimab (CQ9). Two CQs (hydroxychloroquine [CQ3] and ciclesonide [CQ6]) were retrieved in this updated version.
Recommendations:
Favipiravir is not suggested for all patients with COVID-19 (GRADE 2C). Remdesivir is suggested for patients with moderate COVID-19 requiring supplemental oxygen/hospitalization (GRADE 2B). Corticosteroids are recommended for patients with moderate COVID-19 requiring supplemental oxygen/hospitalization (GRADE 1B) and for patients with severe COVID-19 requiring mechanical ventilation/intensive care (GRADE 1A); however, their administration is not recommended for patients with mild COVID-19 not requiring supplemental oxygen (GRADE 1B). Tocilizumab is suggested for patients with moderate COVID-19 requiring supplemental oxygen/hospitalization (GRADE 2B). Anticoagulant administration is recommended for patients with moderate COVID-19 requiring supplemental oxygen/hospitalization and patients with severe COVID-19 requiring mechanical ventilation/intensive care (good practice statement). Baricitinib is suggested for patients with moderate COVID-19 requiring supplemental oxygen/hospitalization (GRADE 2C). Casirivimab/imdevimab is recommended for patients with mild COVID-19 not requiring supplemental oxygen (GRADE 1B). We hope that these updated clinical practice guidelines will help medical professionals involved in the care of patients with COVID-19.
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