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Communique

Weekly Communique # 32

19 November, 2020

WEEK IN REVIEW

BREAKING NEWS: Australian-led REMAP-CAP Trial reports benefit of tocilizumab for critically ill patients with COVID-19.

The REMAP-CAP investigators led by Prof Steve Webb, Monash University, have this evening issued a global media release reporting early findings after the treatment arm investigating the effect of immune modulator tocilizumab met its combination end-point.

The release reports that critically ill patients receiving tocilizumab were more likely to improve (measured by a combination of organ support in the ICU and surviving the hospital admission) compared to patients who received no immune modulator. However, the trial does not yet know the relative benefits of tocilizumab compared to the other immune modulators. Further data are expected in the coming weeks and months.

The Taskforce keenly awaits publication of the peer-reviewed results which will be rapidly incorporated into the Australian guideline recommendations. Due to the absence of high-quality evidence, tocilizimab is currently only recommended for use within the context of randomised trials.

REMAP-CAP is a global platform trial that has to date randomised over 2,000 patients in 15 countries at more than 260 hospitals to multiple treatment combinations for COVID-19. These early findings signal that ground-breaking evidence will shortly be available to guide practice for clinicians around the world treating hundreds of thousands of critically ill patients with COVID-19.

We acknowledge all of the REMAP-CAP investigators, participants and funders for this major contribution to the world’s COVID-19 research effort.

Read the media release here.

High calibre team to join Taskforce/ICEG Panel
The Taskforce received more than 50 applications from a highly accomplished and experienced field of applicants in response to our EOI for members to join the Infection Prevention and Control (IPC) Panel. Nominations have now closed and the selection panel has undertaken a comprehensive review process which has given careful consideration to ensuring clinical diversity, gender diversity, geographical distribution and strong IPC experience.

We look forward to announcing the panel shortly once the appointment process for members has been completed, and to commencing work with the panel early next month.

Preferences and values for respiratory support in children and adolescents
The Taskforce Consumer Panel has reviewed key information for the following list of recommendations related to respiratory support and PIMS-TS in children and adolescents.

  • High-flow nasal oxygen therapy and non-invasive ventilation
  • Prone positioning
  • Respiratory management of the deteriorating child
  • Positive end-expiratory pressure (PEEP)
  • Recruitment manoeuvres
  • Neuromuscular blockers
  • High-frequency oscillatory ventilation (HFOV)
  • Videolaryngoscopy
  • Extracorporeal membrane oxygenation (ECMO)
  • PIMS-TS

The panel provided preferences and values statements on the likelihood that informed patients, parents, carers, families and guardians would agree with the evidence-based or consensus recommendations currently set out in the guideline. In doing so, the panel reflected on a range of scenarios where some or most would agree, as well as occasions when some may not have preferences in-line with a recommendation for reasons unrelated to COVID-19. No changes to the recommendations were proposed.

HELP SHAPE THE GUIDELINES

The second Taskforce impact survey was launched today. 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

  • 29,948 studies published or registered in Cochrane COVID-19 Study Register, 838 added this week
  • 2,098 randomised controlled trials registered (data from Covid-nma site), 47 added this week
  • 2,564 systematic reviews registered in PROSPERO, 40 added this week
  • 121 randomised controlled trials published (data from Covid-nma site), 6 added this week

 

LIVING GUIDELINES

Australian guidelines for the clinical care of people with COVID-19: Version 28.2

NEW RECOMMENDATIONS

  • No new recommendations this week

UPDATES TO EXISTING GUIDANCE

  • Hydroxychloroquine

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

  •  Tocilizumab

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

  • Respiratory support in children and adolescents

The information on preferences and values for respiratory support in children and adolescents have been updated with no change to the strength or directions of the recommendations.

  • VTE prophylaxis for adults

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

  • PIMS-TS

The information on preferences and values for PIMS-TS have been updated with no change to the strength or directions of the recommendations

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:

  • Assessment for suspected COVID-19
  • Management of adults with mild COVID-19
  • Management of adults with moderate to severe COVID-19
  • Management of adults with severe to critical COVID-19
  • 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
  • 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

No changes to flowcharts this week

 

EVIDENCE UNDER REVIEW

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

  • 5-alpha reductase inhibitors NEW
  • Ivermectin prophylaxis NEW
  • Calcifediol UPDATE
  • Combined metabolic cofactor supplementation UPDATE
  • Favipiravir UPDATE
  • Human umbilical cord mesenchymal stem cells UPDATE
  • Immunoglobulin UPDATE
  • Interferon β-1a UPDATE
  • Remdesivir for children and adolescents
  • Care of people recovering from COVID-19/Post-viral syndrome
  • Oestrogen-containing therapies

 

NEWS & EVENTS

Taskforce methods paper published in JClinEpi
Find out more about the Taskforce ‘living evidence’ approach and the important role it’s playing in demonstrating the feasibility of rapid-living GRADE-based guideline development, in a recent paper published in the JClinEpi.  Read here.

ANZICS podcast
Taskforce Executive Director A/Prof Julian Elliott recently joined Dr Swapnil Pawar on the ANZICS podcast. They discussed the processes and challenges involved in forming the world’s first living guidelines for COVID-19. Listen here.

RANZCOG/FIGO Webinar
RANZCOG and the International Federation of Gynaecology and Obstetrics (FIGO) are hosting a webinar: COVID-19 in Australia and New Zealand – a tale of two countries.
Date: Tuesday, November 24
Time: 6pm AEDT
Description: Addressing the experience of the pandemic in Australia and New Zealand, the different strategies, impacts, and lessons learned.Speakers include Taskforce Pregnancy and Perinatal Care Co-Chairs, Dr Vijay Roach and Prof Caroline Homer together with panel members A/Prof Josh Vogel, Dr Michelle Giles, and Dr Clare Whitehead. Register 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.

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