2021 update of the AGIHO guideline on evidence-based management of COVID-19 in patients with cancer regarding diagnostics, viral shedding, vaccination and therapy

Abstract

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Quality of and Recommendations for Relevant Clinical Practice Guidelines for COVID-19 Management: A Systematic Review and Critical Appraisal

“…Five EB-CPGs ( 15 , 19 , 20 , 24 , 34 ) and three CB-CPGs ( 17 , 27 , 41 ) focused on the chemoprophylaxis of COVID-19. Two EB-CPGs of them recommended not to use hydroxychloroquine for COVID-19 pre-exposure prophylaxis or post-exposure prophylaxis outside the setting of a clinical trial ( 15 , 19 ); two EB-CPG ( 20 , 24 ) and two CB-CPGs ( 17 , 27 ) recommended SARS-CoV vaccine for COVID-19 prevention; one CB-CPG ( 41 ) suggested that a few traditional Chinese medicine may be beneficial for COVID-19 prevention, for example, Youngyopaedoc-san plus Bojungikgitang, Youngyopaedoc-san plus Saengmaek-san (See Table 2 ).…”

“…In total, 11 EB-CPGs ( 14 , 20 , 21 , 24 , 26 , 30 , 34 , 36 , 42 , 43 , 51 ) and 7 CB-CPGs ( 32 , 33 , 44 , 46 , 48 , 49 , 52 ) reported the diagnostic criteria for COVID-19 (See Table 3 ). The diagnosis of SARS-CoV-2 infection was mainly based on RT-PCR test, serum-specific antibodies IgM and IgG test, epidemiological history, and clinical manifestations in one EB-CPG ( 34 ) and one CB-CPG ( 46 ).…”

“…The diagnosis of SARS-CoV-2 infection was mainly based on RT-PCR test, serum-specific antibodies IgM and IgG test, epidemiological history, and clinical manifestations in one EB-CPG ( 34 ) and one CB-CPG ( 46 ). However, nine EB-CPGs ( 14 , 20 , 21 , 24 , 26 , 30 , 36 , 43 , 51 ) and six CB-CPGs ( 32 , 33 , 44 , 48 , 49 , 52 ) only focus on one or two of the above criteria. Three CPGs (two EB-CPGs, one CB-CPG) ( 20 , 26 , 32 ) did not suggest SARS-CoV-2 antibody tests for diagnosis of current infection with COVID-19 or as the sole basis or to routinely to diagnose active COVID-19 in symptomatic pregnant women with negative RT-PCR.…”

“…In total, 18 EB-CPGs ( 14 – 16 , 18 , 20 , 21 , 24 – 26 , 34 , 37 , 39 , 40 , 42 , 45 , 47 , 50 , 51 ) and 7 CB-CPGs ( 22 , 23 , 28 , 32 , 38 , 41 , 46 ) provided suggestions on antivirals treatment for COVID-19. As shown in Table 4 , there were no consistent views on effective and validated antiviral drugs such as hydroxychloroquine/chloroquine plus azithromycin, lopinavir/ritonavir, convalescent plasma for the treatment in clinical scenarios.…”

“…The majority of EB-CPGs did not recommend hydroxychloroquine +/– azithromycin to treat patients with COVID-19 because higher certainty benefits (e.g., mortality reduction) are now highly unlikely even if additional high quality randomized controlled trials would become available ( 14 , 15 , 18 , 20 , 21 , 40 , 45 ). Remdesivir is an antiviral drug with potent in vitro activity against a range of RNA viruses including MERS-CoV, SARS-CoV, there may be a favorable risk-benefit profile for remdesivir compared with no antiviral treatment in severe COVID-19 infection with limited safety data currently available for the drug ( 14 – 16 , 20 , 21 , 24 , 25 , 34 , 37 , 47 ). In addition, Traditional Chinese medicine treatment may be beneficial for the treatment of COVID-19, including Lianhua Qingwen granules/capsules and Huashi Baidu granules.…”