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Communique

Communique # 41

01 April, 2021

WEEK IN REVIEW

UPDATES TO THE LIVING GUIDELINE

Convalescent plasma recommendation changed to ‘do not use’
The Taskforce Disease Modifying and Chemoprophylaxis Panel and the Guidelines Leadership Group have incorporated the results of the convalescent plasma arm of the RECOVERY Trial (published March 10) into the body of evidence underpinning the Taskforce’s recommendation on the use of convalescent plasma in treating COVID-19.

As a result, the Taskforce recommendation has been changed to:

Do not use convalescent plasma for the treatment of COVID-19

This recommendation applies to adults, children and adolescents, pregnant and breastfeeding women, older people living with frailty and those receiving palliative care.

Use of convalescent plasma may still be considered in the context of randomised trials with appropriate ethical approval, such as combination therapies that include convalescent plasma.

Evidence comes from nine randomised trials that compared convalescent plasma with standard care in over 12,800 patients with COVID-19. The vast majority of data are from the RECOVERY trial, which included 11,558 adults hospitalised with mild-to-severe COVID-19. The other studies included 160 adults with mild COVID-19, 631 adults with moderate COVID-19 and 525 adults with severe COVID-19.

In the RECOVERY trial, there was no significant difference in the primary endpoint of 28-day mortality (24% per arm). When combined with mortality data from the other included trials, results show that compared with standard care, convalescent plasma probably has little impact on death (16 fewer per 1000 patients; 12,872 patients in 9 studies). In addition, convalescent plasma probably has little impact on the requirement of non-invasive ventilation and has no impact on the requirement of invasive mechanical ventilation or hospital discharge.

Convalescent plasma may increase the incidence of serious adverse events and adverse events, and also increase the rate of resolution of dyspnoea.

The Taskforce has identified two new studies comparing convalescent plasma with standard care (Ray et al.) and (Salman et al.). These studies are currently under review and, although not expected to change the recommendation, will be incorporated into a future version of the guidelines.

Three more treatments added to list of ‘only in clinical trials’
The Disease-Modifying Treatment and Chemoprophylaxis Panel has reviewed the latest evidence for:

  • Bamlanivimab plus etesevimab
  • Enisamium
  • Vitamin C

The Taskforce concludes that there is insufficient evidence to recommend their use outside the context of a randomised trial with appropriate ethical approval.

Updated recommendations

  • Ivermectin
  • PIMS-TS
  • Intravenous immunoglobulin plus corticosteroids (PIMS-TS)
  • Corticosteroids (PIMS-TS)

Further details about these recommendations and additional updates are below.

IPC Healthcare worker consultation
The Taskforce is continuing to recruit frontline healthcare workers to participate in a series of consultations to provide feedback on the implementability of draft infection prevention and control (IPC) recommendations.

We are particularly seeking:

  • nurses working in aged care; and
  • general practitioners and other allied health providers working in primary care.

For further information or to apply click here.

 

QUICK STATISTICS

COVID-19 research pipeline

  • 52,228 studies published or registered in Cochrane COVID-19 Study Register, 2,329 added this fortnight
  • 2,731 randomised controlled trials registered (data from Covid-nma site), 40 added this fortnight
  • 3,673 systematic reviews registered in PROSPERO, 129 added this fortnight
  • 235 randomised controlled trials published (data from Covid-nma site), 12 added this fortnight

 

LIVING GUIDELINES

Australian guidelines for the clinical care of people with COVID-19: Version 37.0

NEW RECOMMENDATIONS

  • Convalescent plasma

Do not use for the treatment of COVID-19.

  • Bamlanivimab plus etesebimab, Enisamium, Vitamin C

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

UPDATED RECOMMENDATIONS

  • Ivermectin

Updated evidence base with no change to the strength or direction of the recommendation.

  • PIMS-TS

Added link to the PAEDS network case definition in information box.

  • Intravenous immunoglobulin plus corticosteroids (PIMS-TS)

One new study added supporting a change in consensus recommendation from ‘consider using intravenous immunoglobulin’ to:

Consider using intravenous immunoglobulin (2 g/kg per dose) in combination with methylprednisolone in children and adolescents who meet PIMS-TS criteria.

  • Corticosteroids (PIMS-TS)

One new study added supporting a change in consensus recommendation from the use of corticosteroids as a second line agent after intravenous immunoglobulin to:

Consider using corticosteroids (irrespective of oxygen status) as adjuvant therapy for children and adolescents diagnosed with PIMS-TS.

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

 

CLINICAL FLOWCHARTS

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

  • Assessment for suspected COVID-19
  • Management of adults with mild COVID-19 UPDATED
  • Management of adults with moderate to severe COVID-19 UPDATED
  • Management of adults with severe to critical COVID-19 UPDATED
  • Respiratory support for adults with severe to critical COVID-19
  • Management of people with COVID-19 who are older and living with frailty and/or cognitive impairment
  • Management of people with COVID-19 who are receiving palliative care
  • Care of people who experience symptoms post acute COVID-19
  • Preparedness for CPR during the COVID-19 pandemic
  • CPR for adults with COVID-19 in healthcare settings
  • Basic life support for adults in the community during the pandemic

Changes to flowcharts this week include:

  • Addition of bamlanivimab plus etesebimab, enisamium, vitamin C to ‘only in clinical trials’
  • Convalescent plasma added to ‘do not use’

 

EVIDENCE UNDER REVIEW

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

  •  P2/N95 respirators and surgical masks
  •  Eye protection
  •  Levels of ventilation
  •  Portable air cleaning devices
  •  Reduction in patient occupancy
  •  Budesonide
  •  CT-P59 (monoclonal antibody)
  •  Interferon beta-1a plus lopinavir-ritonavir
  •  Itraconzole
  •  Levamisole
  •  Proxalutimide
  •  Post-exposure hydroxychloroquine prophylaxis
  •  Immunoglobulin plus methylprednisolone
  •  Care of people with post acute COVID-19

 

NEWS & EVENTS

Cochrane

This week, Cochrane Senior Research Fellow Dr Matthew Page led the publication of PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviewsPRISMA – the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement was first published in 2009, and was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found.
Read more

Consumers Health Forum of Australia
Hosted by CHF, learn how leading clinicians and evidence experts have worked together with consumers to develop clear, consistent and trustworthy guidance that embeds consumer needs into the treatment delivery for COVID-19, and how this model can be used for other chronic disease guidelines in the future.

Webinar: What are ‘living guidelines’ and how are consumers involved?
Date: Tuesday, 27 April 2021
Time: 12:00pm–1:00pm AEST
Panellists:

  • Dr Tari Turner – Director, Evidence and Methods, National COVID-19 Clinical Evidence Taskforce
  • Dr Eleanor Horton – Chair, Consumer Panel, National COVID-19 Clinical Evidence Taskforce
  • Chris Lassig – Consumer Panel Member

Register here

Burnet Institute
The Burnet Institute have published Volume 2 of their COVID-19 Global Trends and Analyses report. It includes a vaccines and viral variants update, and COVID-19 Global snapshots. For more information and to view their earlier publications go to Know C-19, the Burnet Knowledge Hub for COVID-19.

 

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.

Topics