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Communique

Communique # 45

03 June, 2021

Dear colleagues,

On behalf of our 32 Taskforce members, we acknowledge our Victorian colleagues during another challenging and anxious time.

Look after yourselves and each other, and we all hope an easing of restrictions will be possible at the end of next week.

Sincerely,
Sharon McGowan (Chair, Steering Committee) & Julian Elliott (Executive Director)

 

WEEK IN REVIEW

UPDATES TO THE LIVING GUIDELINE

New recommendations

Sarilumab upgraded to a conditional recommendation
The Taskforce Disease-Modifying Treatment and Chemoprophylaxis Panel and the Guidelines Leadership Group have incorporated the recent pre-print results of Sarilumab-COVID-19 Study Team (17 May) into the body of evidence underpinning the Taskforce’s recommendation on the use of sarilumab, an interleukin-6 receptor antagonist.

Evidence now comes from three randomised trials that compared sarilumab with standard care in 450 adults hospitalised with critical COVID-19 requiring organ support and 2238 patients hospitalised with severe–critical COVID-19.

As a result of this meta-analysis the Taskforce has determined sarilumab probably reduces the risk of death in hospitalised adults with COVID-19 who require high-flow oxygen, non-invasive ventilation and invasive mechanical ventilation.

Subsequently, the Taskforce makes the following conditional recommendation:

Consider using sarilumab for the treatment of COVID-19 in adults who require high-flow oxygen, non-invasive ventilation or invasive mechanical ventilation.

The use of sarilumab for the treatment of COVID-19 in special population groups is now under review by the relevant Taskforce clinical panels.

Colchicine changes to Do Not Use
The Taskforce has revised the previous guidance advising that colchicine should only be used to treat COVID-19 in the context of randomised trials to recommending that colchicine is not used to treat COVID-19.

Based on the available evidence, colchicine is no more effective than standard care in treating patients with COVID-19.

Two new treatments added to list of ‘only in clinical trials’

The Taskforce has reviewed the latest evidence for Angiotensin 2 receptor agonist (C21) and Camostat mesilate and concluded that there is insufficient evidence to recommend their use outside the context of a randomised trial with appropriate ethical approval.

Further details about these recommendations and additional updates are below.

REVISED FLOWCHART FOR THE CARE OF POST-ACUTE COVID-19
Following new evidence, together with the recent feedback of the Consumer Panel, through the lens of lived experience, the Primary and Chronic Care Panel have updated the flowchart for the Care of Post-acute COVID-19.

Post-Acute COVID-19 Flowchart

 

TASKFORCE ENDORSES BESSI PRINCIPLES
The BESSI (behavioural, environmental, social and systems interventions) collaboration aims to provide information about planned and completed research into reducing SARS-CoV-2 transmission, and facilitate both novel and replication research. To achieve this, a collaboration of global experts with relevant experience in a wide range of disciplines and sectors need to be brought together to address the problem from a BESSI perspective.

The Taskforce recently endorsed the seven BESSI Principles aimed at improving BESSI awareness, research and implementation for pandemic preparedness.

For further information or to join, go to the BESSI website.

 

QUICK STATISTICS

COVID-19 research pipeline

  • 63,066 studies published or registered in Cochrane COVID-19 Study Register, 1,913 added this fortnight
  • 3,016 randomised controlled trials registered (data from Covid-nma site), 56 added this fortnight
  • 4,224 systematic reviews registered in PROSPERO, 129 added this fortnight
  • 306 randomised controlled trials published (data from Covid-nma site), 9 added this fortnight

 

LIVING GUIDELINES

Australian guidelines for the clinical care of people with COVID-19: Version 40.0

NEW RECOMMENDATIONS

  • Sarilumab

Consider using sarilumab for adults hospitalised with COVID-19 who require high-flow oxygen, non-invasive ventilation or mechanical ventilation.

  • Colchicine

Do not use for the treatment of COVID-19.

  • Angiotensin 2 receptor agonist (C21), Camostat mesilate

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

UPDATED RECOMMENDATIONS

  • Hydroxychloroquine

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

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 with Post-acute COVID-19 UPDATED
  • 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:

  • Revised Post-acute COVID-19 flowchart
  • Sarilumab added as a ‘conditional recommendation’
  • Addition of angiotensin 2 receptor agonist (C21) and comostat mesilate to ‘only in clinical trials’
  • Colchicine added to ‘do not use’

 

EVIDENCE UNDER REVIEW

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

  • Sotrovimab NEW
  • Aerosol generating procedures and behaviours
  • Budesonide
  • Corticosteroids
  • Ivermectin
  • Immunoglobulin plus methylprednisolone
  • Post-exposure hydroxychloroquine prophylaxis
  • Proxalutimide
  • REGN-COV2
  • Sofosbuvir-lepidasvir
  • Care of people with Post-acute COVID-19

 

NEWS & EVENTS

Cochrane
Cochrane recently published an update to Convalescent plasma or hyperimmune immunoglobulin for people with COVID‐19: a living systematic review (May 20) as well as a new review, Vitamin D supplementation for the treatment of COVID‐19: a living systematic review (May 24). Find these and all COVID xxx Cochrane Library.

Upcoming GIN-ANZ Webinar
The Guidelines International Network (GIN) ANZ are hosting an upcoming webinar: The Living guidelines approach—is it achievable and sustainable? It will explore aspects of the ‘living guidelines’ approach using recent projects in stroke and diabetes management.
Date: Friday, 11 June 2021
Time: 11.00 AM AEST
Speakers: Kelvin Hill, National Manager, Clinical Services, Stroke Foundation and Heath White, Senior Evidence Officer and Evidence Lead, Cochrane Australia

RECORDING: MURRAY PHN ‘Long COVID’ webinar
Last week, Taskforce Senior Evidence Officer and Primary and Chronic Care Panel Methods Chair, Dr Samantha Chakraborty joined presenters from the UK’s Royal College of General Practitioners and the National Institute for Health and Care Excellence (NICE) to provide an update on Long COVID symptoms and what we know so far. Facilitated by Dr Norman Swan and Dr Ewa Piejko, view it 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.

Topics