Two years of pandemic: A wealth of data and many remaining questions

Hamilton, Sara E.; Gol'dman, I I; Vos, Kristan van der; Yu, Sha

doi:10.1016/j.xcrm.2022.100581

Cited by 1 publication

(1 citation statement)

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“…The RECOVERY (Randomized Evaluation of COVID-19 therapy), REMAP-CAP (Randomised, Embedded, Multi-factorial, Adaptive Platform Trial for Community-Acquired Pneumonia), and WHO-SOLIDARITY clinical trials were based on extensive multicenter collaboration, adaptive design in randomized controlled trials (RCTs) and the utilization of preprints. They provided an influx of good-quality evidence and led to profound clinical practice changes over time for patients who were not pregnant [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ]. However, it was particularly challenging to derive evidence regarding treatment guidelines for populations with additional treatment safety concerns, such as the pediatric and pregnant patients.…”

Section: Introductionmentioning

confidence: 99%

Evolution of National Guidelines on Medicines Used to Treat COVID-19 in Pregnancy in 2020–2022: A Scoping Review

Maisonneuve

Bruin

Favre

et al. 2023

JCM

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The lack of inclusion of pregnant women in clinical trials evaluating the effectiveness of medicines to treat COVID-19 has made it difficult to establish evidence-based treatment guidelines for pregnant women. Our aim was to provide a review of the evolution and updates of the national guidelines on medicines used in pregnant women with COVID-19 published by the obstetrician and gynecologists’ societies in thirteen countries in 2020–2022. Based on the results of the RECOVERY (Randomized Evaluation of COVID-19 Therapy) trial, the national societies successively recommended against prescribing hydroxychloroquine, lopinavir–ritonavir and azithromycin. Guidelines for remdesivir differed completely between countries, from compassionate or conditional use to recommendation against. Nirmatrelvir–ritonavir was authorized in Australia and the UK only in research settings and was no longer recommended in the UK at the end of 2022. After initial reluctance to use corticosteroids, the results of the RECOVERY trial have enabled the recommendation of dexamethasone in case of severe COVID-19 since mid-2020. Some societies recommended prescribing tocilizumab to pregnant patients with hypoxia and systemic inflammation from June 2021. Anti-SARS-CoV-2 monoclonal antibodies were authorized at the end of 2021 with conditional use in some countries, and then no longer recommended in Belgium and the USA at the end of 2022. The gradual convergence of the recommendations, although delayed compared to the general population, highlights the importance of the inclusion of pregnant women in clinical trials and of international collaboration to improve the pharmacological treatment of pregnant women with COVID-19.

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