关于在严重的COVID-19中使用皮质类固醇的建议的实施
Félix Camirand-Lemyre1, Laura Merson2, Bharath Kumar Tirupakuzhi Vijayaraghavan3,4
1Université de Sherbrooke, Sherbrooke, Quebec, Canada.
JAMA network open
|December 26, 2023
概括
对于严重的COVID-19而言,皮质类固醇的使用在全球范围内有所不同,在临床试验中代表性不足的地区的吸收率较低. 提高研究多样性可以加强指导方针的实施和知识传播.
科学领域:
- 全球健康 全球健康
- 传染性疾病 传染性疾病
- 临床研究 临床研究
背景情况:
- 研究多样性对于信任和有效的生物医学知识至关重要.
- 针对严重的COVID-19治疗的指南建议使用皮质类固醇.
- 治疗时间的地理差异可能会影响患者的治疗结果.
研究的目的:
- 为了比较严重COVID-19的皮质类固醇使用的时间和地理变化.
- 评估RECOVERY试验和世卫组织关于使用皮质类固醇的指导方针的影响.
- 描述临床试验招募的地理分布,以告知世卫组织的建议.
主要方法:
- 在63个国家的434,851名严重COVID-19患者的前性队列研究 (2020年1月-2022年9月).
- 数据是通过国际严重急性呼吸道和新出现感染联盟 (ISARIC) -世卫组织临床表征协议收集的.
- 分析重点是按时间段和世卫组织地理区域分类的皮质类固醇接收.
主要成果:
- 40.1%的患者接受了皮质类固醇; 91.6%的临床试验参与者通知指南来自英国.
- 皮质类固醇的使用在全球范围内增加,但与RECOVERY试验和世卫组织指导方针的一致性仅在欧洲观察到.
- 治疗使用率在美洲 (88.9%) 最高,在非洲 (17.1%) 最低.
结论:
- 在严重的COVID-19中使用皮质类固醇指南的实施显示出显著的地理差异.
- 在临床试验参与有限的地区,治疗率较低.
- 提高研究多样性和代表性可以提高准则的遵守和知识的翻译.
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