Recommendations on the management of coronavirus disease 2019 (COVID-19) were recently released by the National Institutes of Health (NIH) to help guide clinicians caring for patients with COVID-19.
Each recommendation put forth in the guidelines is based on both scientific evidence as well as expert opinion and includes 2 ratings. Letter ratings indicate the strength of the recommendation (A: strong; B: moderate; C: optional) and Roman numeral ratings indicate the quality of evidence supporting that recommendation (I: ≥1 randomized trial that includes clinical outcomes and/or laboratory endpoints; II: ≥1 nonrandomized trial or observational cohort study; III: expert opinion).
Currently, no drugs have been approved by the Food and Drug Administration (FDA) for the treatment of COVID-19. Although reports have been made claiming successful treatment of COVID-19 patients, no drug has been shown to be safe and effective at this time. Recommendations for the clinical management of COVID-19 patients includes both supportive care (supplemental oxygen and mechanical ventilation if necessary) as well as infection control measures.
The guidelines also include recommendations surrounding therapeutic options currently being investigated for the treatment of COVID-19. Due to the lack of sufficient clinical data, recommendations are not being made for or against the use of the following agents: chloroquine, hydroxychloroquine, remdesivir, convalescent plasma, hyperimmune immunoglobulin, interleukin-6-inhibitors (eg, sarilumab, siltuximab, tocilizumab), and interleukin-1 inhibitors (eg, anakinra) (all AIII).
Additionally, the guidelines recommend against the use of the following agents except for in the context of a clinical trial: hydroxychloroquine plus azithromycin, lopinavir/ritonavir (AI), other HIV protease inhibitors, interferons, Janus kinase inhibitors (all AIII unless otherwise indicated).
The use of certain concomitant medications is also discussed in the guidelines. Angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and statins prescribed for the prevention or treatment of cardiovascular disease should be continued in patients diagnosed with COVID-19 (all AIII). These medications are not, however, recommended for the treatment of COVID-19 (all AIII). Additionally, therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) should be continued in patients requiring them for the treatment of a comorbid condition (AIII).
Recommendations surrounding corticosteroid use in patients diagnosed with COVID-19 depend on the severity of a patient’s condition (critically vs non-critically ill). Generally, the use of systemic corticosteroids as treatment for COVID-19 is not recommended unless the patient has acute respiratory distress syndrome (AIII), refractory shock (BII), or is in the intensive care unit (AIII). Patients using oral corticosteroids (for an underlying condition) or inhaled corticosteroids (for asthma, chronic obstructive pulmonary disease) chronically are recommended to continue therapy (AIII).
“Finally, it is important to stress that the rated treatment recommendations in these guidelines should not be considered mandates. The choice of what to do or not to do for an individual patient is ultimately decided by the patient together with their provider,” the expert panel concluded.
The full COVID-19 treatment guidelines can be found here.