Weekly Communique #11

WEEK IN REVIEW

Dexamethasone now under review by the Taskforce

Following Tuesday’s (23 June) pre-print release of results of the dexamethesaone arm of the UK’s RECOVERY study, the Taskforce evidence teams are now reviewing the data and will present recommendations to the Guidelines Leadership Group next week.

New Disease-Modifying Treatments and Chemoprophylaxis Panel

This week we welcomed the formation of a new Disease-Modifying Treatment and Chemoprophylaxis (DMTC) Panel. This panel has been convened to review the high volume of new drug trials expected to be published in the coming weeks and months, and make recommendations on the use of therapeutics for both treatment and prophylaxis in COVID-19.

QUICK STATISTICS

COVID-19 research pipeline

• 10,097 studies published or registered (prevention, diagnosis/prognosis and treatment), 971 added this week
• 1580 clinical trials registered, 74 added this week
• 22 randomised controlled trials published, 1 added this week
• 1420 systematic reviews registered, 93 added this week

NEW OR UPDATED RECOMMENDATIONS

Remdesivir for pregnant patients 
Conditional recommendation against

Use of remdesivir for pregnant patients with COVID-19 outside of a trial setting should not be considered routinely. As pregnant patients are often excluded from clinical trials, use of remdesivir in this population would be outside a clinical trial setting. Pregnant patients receiving remdesivir should nonetheless be enrolled in national COVID-19 registries. Currently, there is no direct evidence of remdesivir in pregnant and breastfeeding patients.

Remdesivir for children and adolescents
Conditional recommendation against

Use of remdesivir for children or adolescents with COVID-19 outside of a trial setting should not be considered routinely. If treatment is considered—in exceptional circumstances—it should be in consultation with a clinical reference group, such as the ANZPID COVID-19 Clinical Reference Group. Informed consent from parents/caregivers should also be obtained.

The Taskforce is continually monitoring research to update recommendations weekly as new evidence accumulates.

Access the Australian guidelines for the clinical care of people with COVID-19

CLINICAL FLOWCHARTS

Five clinical flowcharts have been developed by the Taskforce to cover:

Changes to flowcharts this week reflect: 

• Acknowledgement that access to care may be different in rural and remote settings
• Clarification that the use of remdesivir in mild COVID-19 is not recommended outside of a randomised clinical trial
• Inclusion of latest guidelines from CDNA (V3.3)
• Links to new PPE guidelines from AHPPC for hospital and non-inpatient settings

EVIDENCE UNDER REVIEW

We are currently reviewing evidence to develop recommendations and flowcharts to guide practice in areas including:

• Dexamethasone NEW
• Disease modifying treatments for pregnant woman
• Disease modifying treatments for children and adolescents
• Mode of birth
• Cardiac arrest

NEW TOPICS AND QUESTIONS

It is a core mission of the Taskforce to engage with frontline clinicians to rapidly identify and address priority clinical questions.

Each week we collect suggestions for new clinical questions or topics for consideration by the Taskforce. A document that lists all of the suggested questions, topics and new patient groups that we have received to date is updated each week and available here.

Please encourage your clinical colleagues to provide their insights via the website.

PARTNER UPDATES

NPS MedicineWise 

This week NPS MedicineWise published a news articles and podcast episode for health professionals on dexamethasone. Read the article here and listen to the podcast here. A consumer-friendly article on dexamethasone is also available here.

Australian Commission on Safety and Quality in Healthcare
The Commission has updated its summary review of Potential medicines to treat COVID-19 to include:

• A revised introduction to highlight developments in the large collaborative randomised RECOVERY trial
• Inclusion of dexamethasone in the glucocorticosteroid section
• Update of the hydroxychloroquine entry following retraction of the Lancet Paper and reversal of the FDA decision.