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Communique

Weekly Communique # 8

04 June, 2020

WEEK IN REVIEW

Taskforce issues first conditional recommendation for use of an antiviral treatment for COVID-19

This week, the Taskforce has issued a conditional recommendation on the use of remdesivir:

“Whenever possible remdesivir should be administered in the context of a randomised trial with appropriate ethical approval. Use of remdesivir for adults with moderate, severe or critical COVID-19 outside of a trial setting may be considered.”

The recommendation represents a major milestone in the development of living guidelines for COVID-19. The antiviral drug remdesivir is the first medication to be recommended as a treatment that may be considered for hospitalised patients with COVID-19.

Originally developed for the treatment of Ebola, the pooled meta-analysis of two clinical trials published to date (New England Journal of Medicine and the Lancet) indicate that remdesivir may decrease time to recovery in people with moderate, severe or critical COVID-19.

Taskforce Executive Director, Associate Professor Julian Elliott said while it’s early days, it is a significant step forward.

“This is the first information we have that a drug has a beneficial effect as a treatment for COVID-19. The preliminary data published so far from two clinical trials indicate that it may reduce the time for someone to recover from COVID-19. However, we do not yet have definitive information that remdesivir will reduce mortality, and we expect that data will continue to accumulate to give a stronger indication of the benefits of remdesivir, including for specific sub-groups of patients.

“The importance of continuing to gather high-quality evidence in the context of randomised trials is emphasised by the Taskforce.”

Ordinarily the development of clinical recommendations can take many months but the ‘living’ processes for rapid, robust review of emerging evidence that have been established by the Taskforce have enabled the development of this evidence-based recommendation in less than two weeks.

There are now 10 registered trials on the use of remdesivir in the treatment of COVID-19. The Taskforce will continue to review additional evidence as it is published and update guidance weekly. This includes new results published in the last few days looking at 5 versus 10-day dosing which are being reviewed by the panels this week.

Remdesivir is not licensed for use in Australia, but the Commonwealth Government has approved exemptions to some aspects of the Therapeutic Goods Act to allow the drug to be accessed in the context of clinical trials and for compassionate use. The Taskforce understands that there is sufficient supply of remdesivir in Australia to meet current expected demand.

 


QUICK STATISTICS

COVID-19 research pipeline

  • 6907 studies published (intervention, diagnosis and prevention), 546 added this week
  • 1409 clinical trials registered, 96 added this week
  • 17 randomised controlled trials published, 1 added this week
  • 1131 systematic reviews registered, 81 added this week

Taskforce in numbers

  • 28 member organisations covering primary, acute and critical care settings
  • 12 standing expert panels, leadership groups and independent committees.
  • 186 people contributing to evidence review and updates each week.

 


NEW OR UPDATED RECOMMENDATIONS

Australian guidelines for the clinical care of people with COVID-19: Version 7.0

  • An updated conditional recommendation on the use of remdesivir: “Whenever possible remdesivir should be administered in the context of a randomised trial with appropriate ethical approval. Use of remdesivir for adults with moderate, severe or critical COVID-19 outside of a trial setting may be considered.”

 


CLINICAL FLOWCHARTS

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

  • Assessment for suspected COVID-19
  • Management of mild COVID-19 UPDATED
  • Management of patients with moderate to severe COVID-19 UPDATED
  • Management of patients with severe to critical COVID-19 UPDATED
  • Respiratory support for severe to critical COVID-19

Minor revisions to flowcharts this week reflect: 

  • Updated remdesivir recommendation
  • Inclusion of latest guidelines from CDNA (V3.0)

 


EVIDENCE UNDER REVIEW

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

  • Hydroxychloroquine as post-exposure prophylaxis for COVID-19 NEW
  • Disease modifying treatments for pregnant woman NEW
  • Disease modifying treatments for children and adolescents NEW
  • Mode of birth NEW
  • Cardiac arrest
  • Timing of mechanical ventilation
  • Tracheostomy
  • The use of corticosteroids

 


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 updated each week and available here.

Please encourage your clinical colleagues to provide their insights via the website.


IMPORTANT UPDATES FROM OUR PARTNERS

Consumers Health Forum (CHF)

  • This week CHF and the Taskforce welcomed Dr Susan Whicker to the role of Project Officer supporting our Consumer Panel. The panel is scheduled to hold its first meeting 9 June 2020.

Cochrane

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