The Taskforce has made two new consensus recommendations for the management of children with suspected or confirmed Paediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-CoV-2 (PIMS-TS). The first recommendation emphasises the importance of a multidisciplinary team approach to managing children and adolescents who have suspected or confirmed PIMS-TS, and the potential for rapid deterioration.
The second recommendation supports consideration of the use of intravenous immunoglobulin (IVIg) in these patients. This is a consensus recommendation based on data from experience on its use in other countries and expert opinion, as well as previous experience in the management of Kawasaki Disease (which is related to PIMS-TS and often overlaps). The Taskforce is continually monitoring the literature for emerging evidence in this rare syndrome.
The Paediatric and Adolescent Care Panel are currently reviewing more questions on the management of PIMS-TS, specifically:
The Disease-Modifying Treatment and Chemoprophylaxis Panel has reviewed new trial results for three experimental treatments for COVID-19, concluding that there is still insufficient evidence to recommend their use outside the context of a randomised trial with appropriate ethical approval. They include:
Additional information accompanying the recommendations advises that trials are needed in special populations, including children and adolescents, pregnant and breastfeeding women, older people living with frailty and those receiving palliative care. Until further evidence is available, do not use any of the above drugs in these populations unless they are eligible to be enrolled in trials. (See the individual recommendations below).
Three new studies of hydroxychloroquine for pre-exposure prophylaxis in healthcare workers have been identified. These studies are currently under review and a recommendation will be included in a future update of the guideline.
The Taskforce and the Consumers Health Forum are pleased to announce Eleanor Horton as the new Co-Chair for the Consumer Panel. Eleanor has a strong background in consumer engagement and has previous experience in bringing a consumer voice to the living evidence process through her involvement in the Stroke Living Guidelines developed by the Stroke Foundation. Eleanor will join fellow Co-Chair, Rebecca Randall, on the Guidelines Leadership Group from next week.
Do not use IFN-κ plus TFF2 for the treatment of COVID-19 outside of randomised trials with appropriate ethical approval.
Do not use ivermectin for the treatment of COVID-19 outside of randomised trials with appropriate ethical approval.
Do not use N-acetylcysteine for the treatment of COVID-19 outside of randomised trials with appropriate ethical approval.
Children and adolescents who have suspected or confirmed PIMS-TS should be managed by and discussed with a multidisciplinary team. Because of the potential for rapid deterioration, early consultation with experts and consideration of early transfer to a paediatric hospital with intensive care facilities to manage children are recommended for patients with suspected or confirmed PIMS-TS.
Consider using intravenous immunoglobulin (2 g/kg per dose) in children and adolescents who meet PIMS-TS criteria or have features of Kawasaki disease related to COVID-19.
The evidence base has been updated with no change to the strength or direction of the recommendation. Methylprednisolone has been added as an acceptable alternative.
The evidence base has been updated with no change to the strength or direction of the recommendation.
New section in MAGICapp to indicate new disease-modifying treatments under review
New section in MAGICapp to indicate that we have found three new studies of hydroxychloroquine for pre-exposure prophylaxis in health care workers in our daily searches. These studies are currently under review and a recommendation on its use will be included in a future update of the guideline.
The Taskforce is continually monitoring research to update recommendations weekly as new evidence accumulates.
We are currently reviewing evidence to develop recommendations and flowcharts to guide practice in areas including:
Updates from Cochrane this week include:
The full list of Cochrane Reviews and related content from the Cochrane Library relating to the COVID-19 pandemic can be found here.
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 available here.
Please encourage your clinical colleagues to provide their insights via the website.