Treatment of patients with nonsevere and severe coronavirus disease 2019: an evidence-based guideline

Ye, Zhikang; Rochwerg, Bram; Wang, Ying; Adhikari, Neill K. J.; Murthy, Srinivas; Lamontagne, François; Fowler, Robert; Qiu, Haibo; Li, Wei; Sang, Ling; Loeb, Mark; Shen, Ning; Huang, Minhua; Jiang, Zhongwei; Arabi, Yaseen M.; Colunga‐Lozano, Luis Enrique; Jiang, Li; Koh, Younsuck; Liu, Dong; Liu, Fang; Phua, Jason; Shen, Adong; Huo, Tianyi; Du, Bin; Zhai, Suodi; Guyatt, Gordon

doi:10.1503/cmaj.200648

Cited by 46 publications

(67 citation statements)

References 41 publications

(24 reference statements)

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“…This series of systematic reviews informed a guideline addressing management of patients with COVID-19. 5 Direct evidence from 1 observational study 8 of 84 patients with COVID-19 and ARDS was consistent with the findings of our systematic review of RCTs of patients without COVID-19 that suggested corticosteroids may reduce mortality in patients with COVID-19 and ARDS by more than 15% and reduce the duration of mechanical ventilation. The evidence suggested corticosteroids may increase the rate of serious hyperglycemia, although not of other potentially worrisome adverse effects.…”

Section: Discussionsupporting

confidence: 78%

“…practice guideline addressing management of patients with COVID-19, 5 we conducted a series of systematic reviews. Because we anticipated a paucity of direct evidence from patients with COVID-19, we included available evidence addressing corticosteroids in the treatment of acute respiratory distress syndrome (ARDS), SARS, MERS, influenza and community-acquired pneumonia (CAP), all providing indirect evidence that informs the efficacy and safety of corticosteroid use in patients with COVID-19.…”

Section: Researchmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis

Wang

Colunga‐Lozano

et al. 2020

CMAJ

Self Cite

196

161

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Section: Discussionsupporting

confidence: 78%

Section: Researchmentioning

confidence: 99%

Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis

Wang

Colunga‐Lozano

et al. 2020

CMAJ

Self Cite

196

161

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“…No specific therapeutic agent had demonstrated efficacy in treating patients with covid-19 until recently. This is reflected in multiple clinical practice guidelines that almost exclusively recommend supportive therapy alone, outside the context of a clinical trial 234. Remdesivir is a novel monophosphoramidate adenosine analogue prodrug that impedes viral RNA synthesis and has in vitro antiviral activity against several viral agents 5.…”

mentioning

confidence: 99%

Remdesivir for severe covid-19: a clinical practice guideline

Rochwerg

Agarwal

Zeng

et al. 2020

BMJ

Self Cite

114

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Clinical questionWhat is the role of remdesivir in the treatment of severe covid-19? This guideline was triggered by the ACTT-1 trial published in the New England Journal of Medicine on 22 May 2020.Current practiceRemdesivir has received worldwide attention as a potentially effective treatment for severe covid-19. After rapid market approval in the US, remdesivir is already being used in clinical practice.RecommendationsThe guideline panel makes a weak recommendation for the use of remdesivir in severe covid-19 while recommending continuation of active enrolment of patients into ongoing randomised controlled trials examining remdesivir.How this guideline was createdAn international panel of patients, clinicians, and methodologists produced these recommendations in adherence with standards for trustworthy guidelines using the GRADE approach. The recommendations are based on a linked systematic review and network meta-analysis. The panel considered an individual patient perspective and allowed contextual factors (such as resources) to be taken into account for countries and healthcare systems.The evidenceThe linked systematic review (published 31 Jul 2020) identified two randomised trials with 1300 participants, showing low certainty evidence that remdesivir may be effective in reducing time to clinical improvement and may decrease mortality in patients with severe covid-19. Remdesivir probably has no important effect on need for invasive mechanical ventilation. Remdesivir may have little or no effect on hospital length of stay.Understanding the recommendationMost patients with severe covid-19 would likely choose treatment with remdesivir given the potential reduction in time to clinical improvement. However, given the low certainty evidence for critical outcomes and the fact that different perspectives, values, and preferences may alter decisions regarding remdesivir, the panel issued a weak recommendation with strong support for continued recruitment in randomised trials.

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“…Corticosteroid-based therapy was used in the treatment of the SARS outbreak in 2003 and has also been tested in COVID-19 patients [ 93 , 94 , 95 ]. However, the results have generated controversy and contradiction, with reports recommending both the use of corticosteroids-based treatments in COVID-19 patients and the opposite [ 96 , 97 ].…”

Section: Therapeutic Opportunities For Covid-19 With Impact On Thementioning

confidence: 99%

Gut Microbiota Dysbiosis–Immune Hyperresponse–Inflammation Triad in Coronavirus Disease 2019 (COVID-19): Impact of Pharmacological and Nutraceutical Approaches

2020

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Coronavirus Disease 2019 (COVID-19) is a pandemic infection caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients present a complex clinical picture that, in severe cases, evolves to respiratory, hepatic, gastrointestinal, and neurological complications, and eventually death. The underlying pathophysiological mechanisms are complex and multifactorial and have been summarized as a hyperresponse of the immune system that originates an inflammatory/cytokine storm. In elderly patients, particularly in those with pre-existing cardiovascular, metabolic, renal, and pulmonary disorders, the disease is particularly severe, causing prolonged hospitalization at intensive care units (ICU) and an increased mortality rate. Curiously, the same populations have been described as more prone to a gut microbiota (GM) dysbiosis profile. Intestinal microflora plays a major role in many metabolic and immune functions of the host, including to educate and strengthen the immune system to fight infections, namely of viral origin. Notably, recent studies suggest the existence of GM dysbiosis in COVID-19 patients. This review article highlights the interplay between the triad GM dysbiosis–immune hyperresponse–inflammation in the individual resilience/fragility to SARS-CoV-2 infection and presents the putative impact of pharmacological and nutraceutical approaches on the triumvirate, with focus on GM.

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Treatment of patients with nonsevere and severe coronavirus disease 2019: an evidence-based guideline

Cited by 46 publications

References 41 publications

Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis

Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis

Remdesivir for severe covid-19: a clinical practice guideline

Gut Microbiota Dysbiosis–Immune Hyperresponse–Inflammation Triad in Coronavirus Disease 2019 (COVID-19): Impact of Pharmacological and Nutraceutical Approaches

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