Weekly Communique #33

WEEK IN REVIEW

Updates to the living guideline
Three new recommendations have been published this week covering:

• Bamlanivimab
• Fluvoxamine
• Intravenous immunoglobulin
• VTE prophylaxis for children and adolescents

Further details are below.

Taskforce reviewing changes to WHO guidance on remdesivir for adults
Last week, the World Health Organisation (WHO) modified its recommendation on remdesivir to a conditional recommendation against its use for all hospitalised patients regardless of disease severity. This was triggered by the incorporation of pre-print results from the WHO SOLIDARITY trial published 15 October.

The Taskforce recommendations on remdesivir for adults are currently: ‘Consider using remdesivir for adults hospitalised with COVID-19 who require oxygen but not ventilation’ (conditional recommendation for); and ‘Do not start remdesivir in adults hospitalised with COVID-19 who require ventilation’ (strong recommendation against). These were updated to incorporate the WHO SOLIDARITY pre-print results on 29 October.

The Taskforce is currently liaising directly with the WHO to understand its approach to the assessment of the data and rationale for excluding subgroup analyses based on disease severity. The Taskforce Disease-Modifying Treatment and Chemoprophylaxis Panel will also review key considerations that informed the WHO recommendation to evaluate their consistency with the Australian context.

HELP SHAPE THE GUIDELINES

We are calling on Australian healthcare practitioners to participate in a brief 5-minute survey to help us understand how the guidelines and flowcharts developed by the Taskforce are being used, and how we can improve the value of the guidance we publish.

Feedback is vital to improving the ongoing impact of the guidelines. We would very much appreciate your insights and encourage you to distribute through your clinical networks.

The survey will be open until 11:59pm, Sunday December 6.

QUICK STATISTICS

COVID-19 research pipeline

• 31,432 studies published or registered in Cochrane COVID-19 Study Register, 1,484 added this week
• 2,118 randomised controlled trials registered (data from Covid-nma site), 20 added this week
• 2,616 systematic reviews registered in PROSPERO, 52 added this week
• 129 randomised controlled trials published (data from Covid-nma site), 8 added this week

LIVING GUIDELINES

Australian guidelines for the clinical care of people with COVID-19: Version 29.0

NEW RECOMMENDATIONS

• Bamlanivimab

Do not use bamlanivimab for the treatment of COVID-19 outside of randomised trials with appropriate ethical approval.

• Fluvoxamine

Do not use fluvoxamine for the treatment of COVID-19 outside of randomised trials with appropriate ethical approval

• Intravenous immunoglobulin

Do not use immunoglobulin for the treatment of COVID-19 outside of randomised trials with appropriate ethical approval.

• VTE prophylaxis for children and adolescents

For children and adolescents admitted to hospital with COVID-19, refer to local thromboprophylaxis protocols and seek expert advice.

Trials of thromboprophylaxis in children and adolescents are underway and this recommendation will be updated once new evidence is available.

• There is insufficient evidence in children and adolescents to recommend a modified thromboprophylaxis regimen.
• Consider known risk factors for initiating thromboprophylaxis in children and adolescents.

UPDATES TO EXISTING GUIDANCE

• Remdesivir for children or adolescents

The evidence base has been updated with no change to the strength or direction of the recommendation.

•  Hydroxychloroquine

The evidence base has been updated with no change to the strength or direction of the recommendation.

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

CLINICAL FLOWCHARTS

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

Changes to flowcharts this week include:

• ‘Only in research’ medications updated to include bamlanivimab, fluvoxamine, intravenous immunoglobulin
• CDNA National Guidelines for Public Health Units reference updated to latest version. The updates in this document do not have impact on the guidance in the flowcharts.

EVIDENCE UNDER REVIEW

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

• Ivermectin plus doxycycline NEW
• Peginterferon Lambda-1a NEW
• Calcifediol UPDATE
• Combined metabolic cofactor supplementation UPDATE
• Convalescent plasma UPDATE
• Favipiravir UPDATE
• Human umbilical cord mesenchymal stem cells UPDATE
• Interferon β-1a UPDATE
• Ivermectin UPDATE
• Post exposure hydroxychloroquine prophylaxis UPDATE
• Sofosbuvir-daclatasvir UPDATE
• Care of people recovering from COVID-19/Post-viral syndrome
• Oestrogen-containing therapies

 NEWS & EVENTS

Cochrane

Updates from Cochrane this week include:

• a new editorial, Policy makers must act on incomplete evidence in responding to COVID-19. It addresses how Cochrane has responded to the COVID-19 pandemic, what the limitations to COVID-19 evidence are, and suggestions on how policy makers can move forward with best available evidence;
• an updated review on Physical interventions to interrupt or reduce the spread of respiratory viruses;
• the publication of the diagnostic test accuracy review: Routine laboratory testing to determine if a patient has COVID-19;
• the publication of many new Cochrane Clinical Answers related to COVID-19.The full list of Cochrane Reviews and related content from the Cochrane Library can be found here.

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 available here.

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