Abstract:
There are many pharmacologic therapies that are being used or considered for treatment of coronavirus disease 2019 (COVID-19), with rapidly changing efficacy and safety evidence from trials. The objective was to develop evidence-based, rapid, living guidelines intended to support patients, clinicians, and other healthcare professionals in their decisions about treatment and management of patients with COVID-19. In March 2020, the Infectious Diseases Society of America (IDSA) formed a multidisciplinary guideline panel of infectious disease clinicians, pharmacists, and methodologists with varied areas of expertise to regularly review the evidence and make recommendations about the treatment and management of persons with COVID-19. The process used a living guideline approach and followed a rapid recommendation development checklist. The panel prioritized questions and outcomes. A systematic review of the peer-reviewed and grey literature was conducted at regular intervals. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations. Based on the most recent search conducted on 31 May 2022, the IDSA guideline panel has made 32 recommendations for the treatment and management of the following groups/populations: pre- and postexposure prophylaxis, ambulatory with mild-to-moderate disease, and hospitalized with mild-to-moderate, severe but not critical, and critical disease. As these are living guidelines, the most recent recommendations can be found online at: https://idsociety.org/COVID19guidelines. At the inception of its work, the panel has expressed the overarching goal that patients be recruited into ongoing trials. Since then, many trials were conducted that provided much-needed evidence for COVID-19 therapies. There still remain many unanswered questions as the pandemic evolved, which we hope future trials can answer.
摘要:
背景:有许多药物疗法正在使用或考虑用于治疗2019年冠状病毒病(COVID-19),具有快速变化的疗效和安全性证据。
目标:开发基于证据的,快速,旨在支持患者的生活指南,临床医生,以及其他医疗保健专业人员对COVID-19患者的治疗和管理做出决定。
方法:2020年3月,美国传染病学会(IDSA)成立了由传染病临床医生组成的多学科指南小组,药剂师,和具有不同专业领域的方法学家定期审查证据,并就COVID-19患者的治疗和管理提出建议。该过程使用了生活指南方法,并遵循了快速推荐开发清单。小组优先考虑问题和结果。定期对同行评审和灰色文献进行系统回顾。建议评估的分级,使用开发和评估(GRADE)方法来评估证据的确定性并提出建议。
结果:根据2022年5月31日进行的最新搜索,IDSA指南小组对以下群体/人群的治疗和管理提出了30项建议:暴露前和暴露后预防,患有轻度至中度疾病的门诊,轻度至中度住院,严重但不严重,和危重的疾病。因为这些是生活准则,最新的建议可以在网上找到:https://idsociety.org/COVID19指南。
结论:在其工作开始时,小组表达了一项总体目标,即招募患者参加正在进行的试验.从那以后,许多试验为COVID-19治疗提供了急需的证据.随着大流行的发展,仍然有许多悬而未决的问题,我们希望未来的试验能够回答。