Key summary of German national treatment guidance for hospitalized COVID-19 patients

Abstract

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 D3 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.

Integration of omics data to generate and analyse COVID-19 specific genome-scale metabolic models

“…Vitamin D3 supplementation has been hypothesised to affect clinical outcomes in patients with COVID-19, however; this was not successfully confirmed [ 61 , 67 ]. Currently, vitamin D3 supplementation is not recommended [ 68 ]. However, all studies agree that the lack of randomised controlled studies, small cohorts, different dosages and vitamin D formulations, non-standardised study conditions and large heterogeneity between the studies hinders the evaluation and conclusions.…”

Clinical outcomes of hospitalized COVID-19 patients treated with remdesivir: a retrospective analysis of a large tertiary care center in Germany

“…In this context, the new broad-spectrum antiviral remdesivir, a ribonucleotide analogue that inhibits viral RNA polymerase, has received considerable attention and has been the subject of controversial recommendations: Based on the results of the NIAID-ACTT-1 trial [4], the European Medicines Agency (EMA) concluded that the benefits of remdesivir in COVID-19 patients with pneumonia who require supplemental oxygen (low-or high-flow oxygen therapy or other noninvasive ventilation) outweigh the risks, and that the drug could be approved in the European Union under special conditions; by contrast, the WHO, in its guideline [5] based on the SOLIDARITY trial [6], advises against the use of remdesivir in hospitalized patients with COVID-19. The European Respiratory Society (ERS) and the Association of the Scientific Medical Societies in Germany (AWMF) did not advocate for or against remdesivir therapy in their treatment guidelines because of continuing uncertainties about its potential benefits [7][8][9]. The results of the RECOVERY trial [10] led WHO and EMA to recommend low-dose dexamethasone in COVID-19 patients [5,11].…”

An important call: Suggestion of using IL-10 as therapeutic agent for COVID-19 with ARDS and other complications

“…In fact, IL-10 plays a beneficial role against coronavirus infection. Current clinical guidelines for treating COVID-19 with ARDS is triple therapy: remdesivir, tocilizumab (anti-IL-6 monoclonal antibody), and corticosteroid [ 147 ]. Remdesivir is the anti-SARS-CoV2 agent.…”