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Communique

Weekly Communique # 27

15 October, 2020

WEEK IN REVIEW

New PIMS-TS recommendations

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:

  • Corticosteroids
  • Other immunomodulatory agents
  • Aspirin and antithrombotic agents

New drugs added to list of only in clinical trials

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:

  • Interferon kappa plus trefoil factor 2 (IFN-κ plus TFF2)
  • Ivermectin
  • N-acetylcysteine

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).

Hydroxychloroquine for pre-exposure prophylaxis

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.

Consumer Panel welcomes new Co-Chair

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.

 


QUICK STATISTICS

COVID-19 research pipeline

  • 24,384 studies published or registered in Cochrane COVID-19 Study Register, 1,146 added this week
  • 1,905 randomised controlled trials registered (data from Covid-nma site), 50 added this week
  • 2,344 systematic reviews registered in PROSPERO, 29 added this week
  • 89 randomised controlled trials published (data from Covid-nma site), added this week

Taskforce in numbers

  • 32 member organisations covering primary, acute and critical care settings
  • 15 standing expert panels, leadership groups and independent committees.
  • 239 people contributing to evidence review and updates each week
  • 4,312 citations screened

Taskforce Reach 

  • Website and guideline users: 145,000+
  • Total sessions: 190,000+
  • International sessions: 41,500+
  • Flowchart views: 16,700+

 


LIVING GUIDELINES

Australian guidelines for the clinical care of people with COVID-19: Version 25.0

NEW RECOMMENDATIONS

 

  • Interferon kappa plus trefoil factor 2

Do not use IFN-κ plus TFF2 for the treatment of COVID-19 outside of randomised trials with appropriate ethical approval.

  • Ivermectin

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

  • N-acetylcysteine

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

  • PIMS-TS

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.

  • Intravenous immunoglobulin (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.

UPDATES TO EXISTING GUIDANCE

  • Corticosteroids

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.

  • Convalescent plasma

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

NEW SECTIONS

  • Disease-modifying treatments under review

New section in MAGICapp to indicate new disease-modifying treatments under review

  • Hydroxychloroquine for pre-exposure prophylaxis

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.

 


CLINICAL FLOWCHARTS

Seven 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 UPDATED
  • Management of people with COVID-19 who are receiving palliative care UPDATED

Changes to the flowcharts this week include:

  •  Addition of new drugs to the ‘only in research’ category: IFN-κ plus TFF2, Ivermectin, N-acetylcysteine
  •  Text updates for consistency and clarity

EVIDENCE UNDER REVIEW

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

  • Bromhexine hydrochloride NEW
  • Enoxaparin (therapeutic vs prophylactic) NEW
  • Remdesivir UPDATE
  • Hydroxychloroquine for pre-exposure prophylaxis UPDATE
  • Lopinavir/ritonavir UPDATE
  • Care of people recovering from COVID-19/Post-viral syndrome
  • Oestrogen-containing therapies
  • Paediatric Multisystem Inflammatory Syndrome (PIMS-TS)

 


NEWS & EVENTS

Cochrane

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.

 


NEW TOPICS & 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