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Communique

Weekly Communique # 35

10 December, 2020

WEEK IN REVIEW

Updates to the living guideline

New recommendations published this week cover:

  • Combined metabolic cofactor supplementation (CMCS)
  • Vitamin D analogues (formerly just calcifediol, now also includes cholecalciferol)

Updated recommendations this week include:

  • Interferon β-1a
  • Lopinavir-ritonavir
  • Convalescent plasma
  • Favipiravir
  • Ivermectin
  • Vitamin D analogues (calcifediol/cholecalciferol)
  • Oestrogen-containing therapies
  • Respiratory management of the deteriorating patient

Further details about these recommendations are below.

Consumer panel concludes top-to-bottom review 

This week the Taskforce Consumer Panel prepared preferences and values statements for the following recommendations:

  • Interferon β-1a
  • Lopinavir-ritonavir
  • Oestrogen-containing therapies

There was no change proposed to the strength or direction of the recommendations.

The Consumer Panel has now completed their retrospective review of all recommendations published within the guideline to date. This represents a significant body of work and we once again acknowledge the Panel’s critical role in ensuring the guideline incorporates the values and preferences of consumers.

 

SPOTLIGHT ON TASKFORCE CONTRIBUTORS

The Taskforce is a prime example of the power of cross-disciplinary collaboration and a clear demonstration of the goodwill and generosity of so many in a time of need. There have been extraordinary individual contributions across all aspects of the Taskforce, from within the project team, to our expert clinicians, member organisations, partners and funders.

Throughout the year, Taskforce writer Shauna Hurley has been profiling a selection of these contributors to highlight the role they’ve played in the work of the Taskforce and to provide an opportunity to reflect on the unparalleled year that was 2020.

 

QUICK STATISTICS

COVID-19 research pipeline

  • 33,714 studies published or registered in Cochrane COVID-19 Study Register, 1,171 added this week
  • 2,200 randomised controlled trials registered (data from Covid-nma site), 24 added this week
  • 2,726 systematic reviews registered in PROSPERO, 110 added this week
  • 139 randomised controlled trials published (data from Covid-nma site), 4 added this week

 

LIVING GUIDELINES

Australian guidelines for the clinical care of people with COVID-19: Version 31.0

NEW RECOMMENDATIONS

  • Combined metabolic cofactor supplementation

Do not use combined metabolic cofactor supplementation (CMCS) for the treatment of COVID-19 outside of randomised trials with appropriate ethical approval.

  • Vitamin D analogues (calcifediol/cholecalciferol)

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

UPDATED RECOMMENDATIONS

  • Interferon β-1a, lopinavir-ritonavir, oestrogen-containing therapies

Update to preferences and values with no change to the strength and direction of the recommendation.

  • Convalescent plasma, favipiravir, ivermectin

Update to evidence base with with no change to the strength and direction of the recommendation.

  • Respiratory management of the deteriorating patient

Update to the wording of the remark with with no change to the strength and direction of the recommendation.

  • Oestrogen-containing contraception in women with mild or moderate COVID-19, Oestrogen-containing contraception in women with severe or critical COVID-19

Update to the wording of the recommendation with no change to the strength and direction of the recommendation.

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 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 UPDATED
  • 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

Changes to flowcharts this week include:

  • ‘Only in research’ medications updated to include Vitamin D and CMCS
  • Updated remark in respiratory management of the deteriorating patient to consider preferences and values
  • Addition of recommendations for oestrogen-containing therapies

 

EVIDENCE UNDER REVIEW

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

  • Zinc NEW
  • Convalescent plasma UPDATED
  • Favipiravir UPDATED
  • Hydroxychloroquine UPDATED
  • Hydroxychloroquine plus azithromycin UPDATED
  • Immunoglobulin plus methylprednisolone UPDATED
  • Ivermectin UPDATED
  • Ivermectin plus doxycycline UPDATED
  • Care of people recovering from COVID-19/Post-viral syndrome

 

NEWS & EVENTS

Cochrane

This week Cochrane has published:

The full list of Cochrane Reviews and related content from the Cochrane Library relating to the COVID-19 pandemic can be found here.

NPS MedicineWise

NPS MedicineWise CEO Adj A/Prof Steve Morris catches up with Taskforce Executive Director A/Prof Julian Elliott in their latest podcast, Episode 20: Medicines for COVID-19 – where did we land?.  They discuss how 2020 played out in terms of the top medicines that were touted as treatments for COVID-19, the emerging areas of evidence, and how clinicians on the ground have been applying the living guidelines.

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