Japanese rapid/living recommendations on drug management for COVID‐19

Abstract

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‐SSCGs. 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 (ver. 3.1) (released on March 30, 2021). Clinical questions (CQs) were set for the following seven drugs: favipiravir (CQ1), remdesivir (CQ‐2), hydroxychloroquine (CQ‐3), corticosteroids (CQ‐4), tocilizumab (CQ‐5), ciclesonide (CQ‐6), and anticoagulants (CQ‐7). Favipiravir is recommended for patients with mild COVID‐19 not requiring supplemental oxygen (GRADE 2C); remdesivir for moderate COVID‐19 patients requiring supplemental oxygen/hospitalization (GRADE 2B); hydroxychloroquine is not recommended for all COVID‐19 patients (GRADE 1B); corticosteroids are recommended for moderate COVID‐19 patients requiring supplemental oxygen/hospitalization (GRADE 1B) and severe COVID‐19 patients requiring ventilator management/intensive care (GRADE 1A); however, their administration is not recommended for mild COVID‐19 patients not requiring supplemental oxygen (GRADE 1B); tocilizumab is recommended for moderate COVID‐19 patients requiring supplemental oxygen/hospitalization (GRADE 2B); and anticoagulant therapy for moderate COVID‐19 patients requiring supplemental oxygen/hospitalization and severe COVID‐19 patients requiring ventilator management/intensive care (GRADE 2C). We hope that these clinical practice guidelines will aid medical professionals involved in the care of COVID‐19 patients.

Low SARS-CoV-2 antibody titers may be associated with poor clinical outcomes for patients with severe COVID-19

“…The definition of severe disease was “patients who needed ventilators (including extracorporeal membrane oxygenation: ECMO) or patients who needed high concentration oxygen therapy of 5 L or more.” The definition of illness severity varied across guidelines. Japanese guidelines defined severe illness in patients who required ventilator management or intensive care management 28 . This study was conducted during the COVID-19 pandemic, and each municipality made its own efforts to avoid medical disruption.…”

COVID-19 Omicron variant-induced laryngitis

“…This principle is also true in COVID-19 cases. However, the severity of COVID-19 cases is still primarily judged based on pneumonia symptoms, which are determined by measuring blood oxygen saturation levels [4] . Cases of upper airway stenosis with laryngitis wherein blood oxygen levels have not yet decreased, such as the present case, are diagnosed as mild COVID-19 and are, consequently, ineligible for hospitalization or emergency transport.…”

“…During acute inflammation with upper respiratory tract stenosis, such as in this case, the systemic administration of corticosteroid, which has strong anti-inflammatory properties, is the first choice for symptomatic treatment. However, corticosteroids are not recommended in COVID-19 cases that do not require oxygen therapy [4] . Therefore, symptoms indicating upper airway stenosis should be carefully observed.…”

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

“…The first edition of this clinical practice guideline was released on September 9, 2020, and the English edition was previously published. 1 , 2 This document is the revised 5.0 edition (released on July 15, 2021; Table 1 , Fig. 1 ).…”