In this episode, I’ll discuss the new NIH guidelines on therapeutic options for COVID-19.
On April 21, the NIH published expert consensus guidelines on the treatment of COVID-19.
As these guidelines are evidence-based, and we have not had enough time for the rigorous testing of therapies against COVID-19, there are no positive recommendations on the use of therapeutics for COVID-19. Instead, recommendations are either “neutral” or “against unless in the context of a clinical trial.”
The main recommendation from these guidelines that is leading to changes in practice is where the authors come down on the combination of hydroxychloroquine and azithromycin.
The guidelines state the following regarding the use of therapeutic agents for COVID-19 treatment:
Antivirals:
- There are insufficient clinical data to recommend either for or against using chloroquine or hydroxychloroquine for the treatment of COVID-19 (AIII).
- If chloroquine or hydroxychloroquine is used, clinicians should monitor the patient for adverse effects, especially prolonged QTc interval (AIII).
- There are insufficient clinical data to recommend either for or against using the investigational antiviral drug remdesivir for the treatment of COVID-19 (AIII).
- Remdesivir as a treatment for COVID-19 is currently being investigated in clinical trials and is also available through expanded access and compassionate use mechanisms for certain patient populations.
- Except in the context of a clinical trial, the COVID-19 Treatment Guidelines Panel (the Panel) recommends against the use of the following drugs for the treatment of COVID-19:
- The combination of hydroxychloroquine plus azithromycin (AIII) because of the potential for toxicities.
- Lopinavir/ritonavir (AI) or other HIV protease inhibitors (AIII) because of unfavorable pharmacodynamics and negative clinical trial data.
Host Modifiers/Immune-Based Therapy:
- There are insufficient clinical data to recommend either for or against the use of convalescent plasma or hyperimmune immunoglobulin for the treatment of COVID-19 (AIII).
- There are insufficient clinical data to recommend either for or against the use of the following agents for the treatment of COVID-19 (AIII):
- Interleukin-6 inhibitors (e.g., sarilumab, siltuximab, tocilizumab)
- Interleukin-1 inhibitors (e.g., anakinra)
- Except in the context of a clinical trial, the Panel recommends against the use of other immunomodulators, such as:
- Interferons (AIII), because of lack of efficacy in treatment of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) and toxicity.
- Janus kinase inhibitors (e.g., baricitinib) (AIII), because of their broad immunosuppressive effect.
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