Remdesivir for severe covid-19: a clinical practice guideline

被引：82

作者：

Rochwerg, Bram ^{[1
,2
]}

Agarwal, Arnav ^{[1
,3
]}

Zeng, Linan ^{[1
,4
]}

Leo, Yee-Sin ^{[5
]}

Appiah, John Adabie ^{[6
]}

Agoritsas, Thomas ^{[1
,7
,8
]}

Bartoszko, Jessica ^{[1
]}

Brignardello-Petersen, Romina ^{[1
]}

Ergan, Begum ^{[9
]}

Ge, Long ^{[1
,10
,11
]}

Geduld, Heike ^{[12
]}

Gershengorn, Hayley B. ^{[13
,14
]}

Manai, Hela ^{[15
]}

Huang, Minhua ^{[16
]}

Lamontagne, Francois ^{[17
]}

Kanda, Seema ^{[18
]}

Kawano-Dourado, Leticia ^{[19
,20
]}

Kurian, Linda ^{[21
]}

Kwizera, Arthur ^{[22
]}

Murthy, Srinivas ^{[23
]}

Qadir, Nida ^{[24
]}

Siemieniuk, Reed ^{[1
]}

Silvestre, Maria Asuncion ^{[25
,26
]}

Vandvik, Per Olav ^{[27
]}

Ye, Zhikang ^{[1
]}

Zeraatkar, Dena ^{[1
]}

Guyatt, Gordon ^{[1
,13
]}

机构：

[1] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[2] McMaster Univ, Dept Med, Hamilton, ON, Canada

[3] Univ Toronto, Dept Med, Toronto, ON, Canada

[4] Sichuan Univ, West China Second Univ Hosp, Dept Pharm, Evidence Based Pharm Ctr, Chengdu, Peoples R China

[5] Natl Ctr Infect Dis, Singapore, Singapore

[6] Kwame Nkrumah Univ Sci & Technol, Kumasi, Ghana

[7] Univ Hosp Geneva, Div Gen Internal Med, Geneva, Switzerland

[8] Univ Hosp Geneva, Div Clin Epidemiol, Geneva, Switzerland

[9] Dokuz Eylul Univ, Dept Pulm & Crit Care, Sch Med, Izmir, Turkey

[10] Lanzhou Univ, Sch Publ Hlth, Evidence Based Social Sci Res Ctr, Lanzhou, Peoples R China

[11] Lanzhou Univ, Sch Publ Hlth, Dept Social Med & Hlth Management, Lanzhou, Peoples R China

[12] Stellenbosch Univ, Fac Med & Hlth Sci, Div Emergency Med, Cape Town, South Africa

[13] Univ Miami, Miller Sch Med, Div Pulm Crit Care & Sleep Med, Miami, FL 33136 USA

[14] Albert Einstein Coll Med, Div Crit Care Med, Bronx, NY 10467 USA

[15] Emergency Med Serv, Fac Med, Tunis, Tunisia

[16] Guangdong Kuaiwen Informat Technol Co LTD, Guangzhou, Guangdong, Peoples R China

[17] CHU Sherbrooke, Ctr Rech, Dept Med, Sherbrooke, PQ, Canada

[18] McMaster Univ Alumnus, Hamilton, ON, Canada

[19] Univ Sao Paulo, Heart Inst InCor HCFMUSP, Div Pulm, Sch Med, Sao Paulo, Brazil

[20] Hosp Coracao HCor, Res Inst, Sao Paulo, Brazil

[21] Donald & Barbara Zucker Sch Med Hofstra Northwell, Div Hosp Med, Hempstead, NY USA

[22] Makerere Univ, Coll Hlth Sci, Dept Anaesthesia & Crit Care, Kampala, Uganda

[23] Univ British Columbia, Fac Med, Vancouver, BC, Canada

[24] Univ Calif Los Angeles, David Geffen Sch Med, Div Pulm & Crit Care Med, Los Angeles, CA 90095 USA

[25] Kalusugan Ng Mag Ina Hlth Mother & Child Inc, Quezon City, Philippines

[26] Asia Pacific Ctr Evidence Based Healthcare, Manila, Philippines

[27] Univ Oslo, Inst Hlth & Soc, Dept Hlth Econ & Hlth Management, Oslo, Norway

来源：

BMJ-BRITISH MEDICAL JOURNAL | 2020年 / 370卷

关键词：

TRIALS; GRADE;

D O I：

10.1136/bmj.m2924

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

CLINICAL QUESTION What 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 PRACTICE Remdesivir 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. RECOMMENDATIONS The 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 CREATED An 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 EVIDENCE The 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 RECOMMENDATION Most 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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页数：10

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