Japanese rapid/living recommendations on drug management for COVID‐19: updated guidelines (July 2022)

Abstract

Background Coronavirus disease (COVID‐19), an infectious disease caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), 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 recommendations. The first edition of this guideline was released on September 9, 2020, and this is the revised edition (version 5.0; released on July 15, 2022). Clinical questions (CQs) were set for the following 10 drugs: favipiravir (CQ1), remdesivir (CQ2), corticosteroids (CQ4), tocilizumab (CQ5), anticoagulants (CQ7), baricitinib (CQ8), casirivimab/imdevimab (CQ9‐1), sotrovimab (CQ9‐2), molnupiravir (CQ10), and nirmatrelvir/ritonavir (CQ11). Recommendations Favipiravir is not suggested for all patients with COVID‐19 (GRADE 2C). Remdesivir is suggested for patients with mild COVID‐19 who do not require oxygen, and patients with moderate COVID‐19 requiring supplemental oxygen/hospitalization (both GRADE 2B). Corticosteroids are recommended for moderate and severe COVID‐19 (GRADE 1B, 1A). However, their administration is not recommended for mild COVID‐19 (GRADE 1B). Tocilizumab is suggested for moderate and severe COVID‐19 (GRADE 2B, 2C). Anticoagulant administration is recommended for moderate and severe COVID‐19 (Good Practice Statement). Baricitinib is suggested for moderate and severe COVID‐19 (both GRADE 2C). Casirivimab/imdevimab and sotrovimab are recommended for mild COVID‐19 (both GRADE 2C). Molnupiravir and nirmatrelvir/ritonavir are recommended for mild COVID‐19 (both GRADE 2C). SARS‐CoV‐2 mutant strains emerge occasionally, and each time, the treatment policy at clinics is forced to change drastically. We ask health‐care professionals in the field to refer to the recommendations in these guidelines and use these to keep up to date with COVID‐19 epidemiological information.

Two Years of Experience and Methodology of Korean COVID-19 Living Clinical Practice Guideline Development

“… 25 26 Japan has also published two English versions of rapid/living recommendations, including medication treatments. 27 28 The WHO and Japanese recommendations included infographic figures ( Supplementary Figure 1 ) that are useful for understanding recommendations and accelerating feasibility. These activities increased the accessibility of guidelines during the pandemic and reduced the efforts for evidence synthesis.…”

Myocardial Injury by COVID-19 Infection Assessed by Cardiovascular Magnetic Resonance Imaging ― A Prospective Multicenter Study ―

“…This research is distinct from the COVID-19 study led by the Japanese Respiratory Society and involved prospective patient enrollment. To be eligible for inclusion in the present study, patients had to have COVID-19 of moderate or higher severity according to the Ministry of Health, Labour and Welfare severity criteria 14 and to meet any one of the following: (1) high-sensitivity troponin positivity confirmed at least once during hospitalization or at the 3-month follow-up; (2) high-sensitivity troponin value recorded during hospitalization or up to 3 months after discharge, with a confirmed increase of ≥50% from the time of admission (or ≥150% of the measured sensitivity concentration if the time of admission was below the measured sensitivity); and (3) B-type natriuretic peptide (BNP) ≥100 pg/mL or N-terminal pro BNP (NT-proBNP) ≥300 pg/mL during hospitalization or up to 3 months after discharge. Patients with known coronary artery disease (myocardial infarction or angina pectoris) or heart failure Secondary endpoints included an examination of the frequency of native T1 abnormalities by T1 mapping.…”

Steroid Pulse Therapy as a Treatment for Patients With COVID-19 Pneumonia at an Intensive Care Unit: A Single-Center Retrospective Observational Study

“…The Japanese COVID-19 guidelines [ 3 ] do not provide recommendations for steroid pulse therapy. This recommendation was developed based on the findings of two low-quality RCTs [ 4 , 8 ], one of which [ 4 ] evaluated a corticosteroid dose different from the dose commonly used in Japan.…”

“…For example, remdesivir is recommended for hospitalized patients with severe COVID-19 pneumonia, who are not on mechanical ventilation because some data suggest that it may reduce the time to recovery and the risk of mechanical ventilation [1,2]. The current Japanese guidelines also recommend corticosteroids for patients with COVID-19 pneumonia who require oxygen [3]. However, the optimal dose and duration of corticosteroid administration remain unclear.…”