COVID-19 Update for 4/24/2020

Remdesivir

Preliminary results from the Chinese Phase III COVID-19 trials in patients with severe infections (NCT04257656) were posted on the WHO web site and then taken down. STAT reported on the data and posted a screen shot of the data before it was taken down. The single paragraph reported no benefit with remdesivir. These reports are too preliminary, since at this point, we do not know what other treatments were given to the patients. It should also be noted that patients could receive the drug up to 12 days after developing symptoms, which may be beyond the window for effective use of the drug. At this time, it would be better to wait until the results are published in a reviewed article.

Hydroxychloroquine and Chloroquine

A posted retrospective review of 368 patients hospitalized with confirmed CPVOD-19 at a U.S. Veterans Health Administration medical centers found that hydroxychloroquine alone or with azithromycin did not decrease the need for mechanical ventilation compared to supportive care, and patients treated with hydroxychloroquine alone had higher mortality. However, patients in the study that received hydroxychloroquine alone or with azithromycin were more likely to have more severe disease, so as the authors note it is expected there will be higher mortality in the group that received the drugs. The authors used propensity score to control for characteristics/covariates, but in its current form, the study does not provide enough details to assess their conclusions, so please wait until the final published article is available before using the data in this article for patient care decisions.

The Department of Justice approved AmerisourceBergen to distribute hydroxychloroquine from the U.S. Strategic National Stockpile based on volumes and ship-to destinations identified by the government. Hydroxychloroquine is being provided at no cost to health care providers as part of the COVID-19 emergency efforts lead by FEMA and HHS.

General COVID-19 Research News

The National Institutes of Health (NIH) published guidelines on treating patients with COVID-19. The guidelines do not recommend any pre- or post-exposure pharmacotherapy prophylaxis outside of clinical trials. The guideline panel did not find enough evidence to recommend using or not using any drug for the treatment of COVID-19 regardless of severity.

The Society of Critical Care Medicine has provided Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19) as an expansion of their Surviving Sepsis Campaign. The guideline focuses on critically ill patients and provides guidance in four areas with 50 recommendations to recommend for or against an option or if there is insufficient evidence to make a recommendation. 

The American Thoracic Society has published COVID‐19: Interim Guidance on Management Pending Empirical Evidence that focuses specifically on drug therapies and ventilation. The guidelines also include the results of voting by the panel on interventions. An intervention required a minimum of 70% of the panel to vote for the intervention for it be included as a recommendation.