COVID-19 treatment guidelines: IDSA scrutinizes experimental agents

  • Bhimraj A & al.
  • Clin Infect Dis
  • 27 Apr 2020

  • curated by Liz Scherer
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • COVID-19 treatment guidelines from the Infectious Disease Society of America (IDSA) reinforce the lack of strong evidence for unproven agents in the hospital setting.
  • Agents are recommended only in the context of a clinical trial.

Why this matters

  • Clinicians should consider tradeoffs between highly uncertain benefits for hospitalized patients with COVID-19 and known putative harms.

Key points

  • With hydroxychloroquine/chloroquine alone or plus azithromycin (very low evidence):
    • Clinical progression on radiology:
      • Risk ratio (RR): 0.61 (95% CI, 0.26-1.43). 
    • Viral clearance by RT-PCR:
      • RR: 2.00 (95% CI, 0.02-20.00). 
    • Adverse events (AEs) include significant QT prolongation, QT increase >500 milliseconds or discontinuation.
  • Lopinavir/ritonavir (very low evidence): 
    • Modified intention-to-treat, mortality: RR, 0.67 (95% CI, 0.38-1.17).
    • ~14% of recipients failed to complete trials because of AEs.
  • Corticosteroids for hospitalized patients with acute respiratory distress syndrome or COVID-19 pneumonia (very low evidence): data limitations prevent sensible pooling of potential treatments.
    • Continue inhaled/systemic agents for other indications.
  • Tocilizumab (very low evidence): high bias risk precludes definitive conclusions.
    • Potential AEs: serious infections, hepatitis B reactivation, anaphylaxis, severe liver damage, hepatic failure. 
  • Convalescent plasma (very low evidence): high bias risk, imprecision; no deaths or serious AEs reported.
  • Consult guidelines for treatments under evaluation.