PURPOSE: This executive summary of a national living guideline aims to provide rapid evidence based recommendations on the role of drug interventions in the treatment of hospitalized patients with COVID-19. METHODS: The guideline makes use of a systematic assessment and decision process using an evidence to decision framework (GRADE) as recommended standard WHO (2021). Recommendations are consented by an interdisciplinary panel. Evidence analysis and interpretation is supported by the CEOsys project providing extensive literature searches and living (meta-) analyses. For this executive summary, selected key recommendations on drug therapy are presented including the quality of the evidence and rationale for the level of recommendation. RESULTS: The guideline contains 11 key recommendations for COVID-19 drug therapy, eight of which are based on systematic review and/or meta-analysis, while three recommendations represent consensus expert opinion. Based on current evidence, the panel makes strong recommendations for corticosteroids (WHO scale 5-9) and prophylactic anticoagulation (all hospitalized patients with COVID-19) as standard of care. Intensified anticoagulation may be considered for patients with additional risk factors for venous thromboembolisms (VTE) and a low bleeding risk. The IL-6 antagonist tocilizumab may be added in case of high supplemental oxygen requirement and progressive disease (WHO scale 5-6). Treatment with nMABs may be considered for selected inpatients with an early SARS-CoV-2 infection that are not hospitalized for COVID-19. Convalescent plasma, azithromycin, ivermectin or vitamin D(3) should not be used in COVID-19 routine care. CONCLUSION: For COVID-19 drug therapy, there are several options that are sufficiently supported by evidence. The living guidance will be updated as new evidence emerges.
- Malin, J. J.
- Spinner, C. D.
- Janssens, U.
- Welte, T.
- Weber-Carstens, S.
- Schälte, G.
- Gastmeier, P.
- Langer, F.
- Wepler, M.
- Westhoff, M.
- Pfeifer, M.
- Rabe, K. F.
- Hoffmann, F.
- Böttiger, B. W.
- Weinmann-Menke, J.
- Kersten, A.
- Berlit, P.
- Krawczyk, M.
- Nehls, W.
- Fichtner, F.
- Laudi, S.
- Stegemann, M.
- Skoetz, N.
- Nothacker, M.
- Marx, G.
- Karagiannidis, C.
- Kluge, S.
Keywords
- Covid-19
- Living guideline
- Living meta-analysis
- SARS-CoV-2
- of travel expenses from Gilead Sciences, Eli Lilly, Janssen-Cilag, MSD and received
- consultancy fees from Molecular Partners and Formycon in the context of COVID-19. He
- also received research support indirectly from Apeiron, Eli Lilly, Gilead Sciences,
- and Janssen-Cilag. Outside this context, he received consultancy fees, speaker’s
- honoraria, and reimbursement of travel expenses from AbbVie, Gilead Sciences,
- Janssen-Cilag, MSD, and ViiV Healthcare/GSK, as well as research support (indirectly
- to his employer) from Gilead Sciences, GSK, Jansen-Cilag, MSD, and ViiV Healthcare.
- T. Welte received consultancy fees from AstraZeneca, Basilea, Biotest, Bayer,
- Boehringer, GSK, Janssens, Novartis, Pfizer and Roche. He received lecture fees and
- travel cost support from AstraZeneca, Basilea, Biotest, Bayer, Boehringer, Berlin
- Chemie GSK, Infectopharm, MSD, Novartis, Pfizer, Roche and research support By DFG,
- BMBF, EU, WHO. S. Weber-Carstens is working in a scientific cooperation project with
- the company Dräger. F. Langer has received personal fees for lectures, advisory
- boards or consultancy and/or research support from Aspen, Bayer, Boehringer
- Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, LEO Pharma, Pfizer, and Sanofi,
- outside the submitted work. M. Westhoff received lecture honoraria from Actelion,
- Boehringer, Novartis, Löwenstein, and research support from Bayer. M. Pfeifer
- received lecture fees from Astra-Zeneca, Boehringer, Chiesi, Glaxo-Smith-Kline,
- Novartis, and Roche. He received consulting fees from Boehringer, Chiesi, Novartis,
- and Roche, and travel support from Boehringer. K. F. Rabe has received consultancy
- fees from AstraZeneca, Boehringer, Sanofi Aventis, MSD, and Novartis. He received
- lecture fees and travel support from Roche, Chiesi Pharmaceuticals, Pfizer, TEVA
- Pharmaceuticals, Orion Cooperation, Berlin Chemie, Boehringer, AstraZeneca, MSD,
- Novartis, and Sanofi Aventis, research support from the German Federal Ministry of
- Education and Research. B. W. Böttiger received fees for lectures from the following
- companies: Forum für medizinische Fortbildung (FomF), Baxalta Deutschland GmbH, ZOLL
- Medical Deutschland GmbH, C.R. Bard GmbH, GS Elektromedizinische Geräte G. Stemple
- GmbH, Novartis Pharma GmbH, Philips GmbH Market DACH, Bioscience Valuation BSV GmbH.
- J. Weinmann-Menke received research support from GSK, DIAMED, Miltenyi Biotech,
- lecture fees from Astellas, Astra Zeneca, Norvartis, Bial, Roche, Chiesi, GSK,
- Boehringer-Ingelheim, Miltenyi, Bayer, Vifor, Fresenius. She received consultancy
- fees from Bayer, Bial, Boehringer-Ingelheim, Chiesi, Astra Zeneca and GSK. M.
- Nothacker is a guideline methodologist payed by the AWMF. G. Marx received
- consultancy fees and research support from Biotest, B.Braun, and Adrenomed, and
- lecture fees from B.Braun, Biotest, and Philips. He holds a patent for modulation of
- the TLR4 signaling pathway (European Patent 2855519). C. Karagiannidis has received
- consultancy fees from Bayer and Xenios. S. Kluge has received research support from
- Ambu, Daiichi Sankyo, ETView Ltd, Fisher & Paykel, Pfizer, and Xenios. He has
- received lecture honoraria from Astra, C.R. Bard, Baxter, Biotest, Cytosorbents,
- Daiichi Sankyo, Fresenius, Gilead, Mitsubishi Tanabe Pharma, MSD, Pfizer, Philips,
- ZOLL. He received consultancy fees from Bayer, Fresenius, Gilead, MSD and Pfizer. J.
- J. Malin, U. Janssens, G. Schälte, P. Gastmeier, M. Wepler, F. Hoffmann, A. Kersten,
- P. Berlit, M. Krawczyk, W. Nehls, F. Fichtner, S. Laudi, M. Stegemann and N. Skoetz
- report no potential conflicts of interest.
