This week we experienced a shift in the level of alert among the clinicians who form Australia’s frontline healthcare response to COVID-19, particularly in Victoria.
As our colleagues rally, we will continue to update guidance weekly to ensure that all Australian clinicians have access to clear, consistent, evidence-based guidance based on up-to-the minute research during the pandemic. We are extremely grateful to members of the Taskforce who volunteer their time week-in and week-out to make this happen.
RECOVERY trial: Hydroxychloroquine arm preprint results
The Taskforce notes the publication of the preprint results of the RECOVERY trial on 15 July that concluded that hydroxychloroquine was not associated with reductions in 28-day mortality in patients hospitalised with COVID-19, but was associated with an increased length of hospital stay and increased risk of progressing to invasive mechanical ventilation or death. We are currently incorporating these results in the guidelines.
Dexamethasone in pregnancy/breastfeeding, children and adolescents
This week the Taskforce’s special populations panels issued guidance on Dexamethasone in pregnant or breastfeeding women, and in children and adolescents (noting that these are interim recommendations awaiting complete reporting of the RECOVERY trial).
Upgraded evidence for continuing ACEIs/ARBs
At present, no randomised trials have investigated the benefits of continuing or stopping ACEIs/ARBs in patients with COVID-19. Despite the very low certainty evidence that continued use of concomitant ACEIs/ARBs increases or decreases mortality or disease severity in patients with COVID-19, there is high certainty evidence of harm if ACEIs/ARBs are stopped abruptly in patients who are already receiving them. Stopping these medications could lead to acute heart failure or unstable blood pressure. The Taskforce has strengthened its recommendation around continuation of these medications in people with COVID-19 (see recommendation summary below).
Working in partnership with our Consumer Panel
Drawing on advice from the Consumer Panel, the guidelines have been updated to incorporate a statement on the use of language around pregnancy and perinatal care:
“The Taskforce recognises that individuals have diverse gender identities. Terms such as pregnant person, childbearing people and parent can be used to avoid gendering birth, and those who give birth, as feminine. However, because women are also marginalised and oppressed in most places around the world, we have continued to use the terms woman, mother or maternity. When we use these words, it is not meant to exclude those who give birth and do not identify as women.”
The Taskforce Consumer Panel is co-convened with our Community Partner, the Consumers Health Forum of Australia.
COVID-19 research pipeline
Dexamethasone for pregnant or breastfeeding women
Conditional recommendation
- Consider using dexamethasone 6 mg daily intravenously or orally for up to 10 days in pregnant or breastfeeding women with COVID-19 who are receiving oxygen (including mechanically ventilated patients).
*Interim awaiting complete reporting: This recommendation will be revisited when more complete and detailed reporting of this comparison of the RECOVERY trial is made available.
Conditional recommendation against
- Do not routinely use dexamethasone to treat COVID-19 in pregnant or breastfeeding women who do not require oxygen.
*Interim awaiting complete reporting: Antenatal corticosteroids should still be used for fetal lung maturation in pregnant women at risk of preterm birth who also have COVID-19. Dexamethasone should still be used for other evidence-based indications in pregnant and breastfeeding women who have COVID-19. This recommendation will be revisited when more complete and detailed reporting of this comparison of the RECOVERY trial is made available.
Dexamethasone for children or adolescents
Conditional recommendation
- Consider using dexamethasone daily intravenously or orally for up to 10 days in children and adolescents with COVID-19 who are receiving oxygen (including mechanically ventilated).
* Interim awaiting complete reporting: A dose of 6 mg daily was used for adults; the protocol stated a dose of 0.15 mg/kg/day to a maximum of 6 mg/day for children but it is unclear how many children were included in the trial. This recommendation will be revisited when more complete and detailed reporting of this comparison of the RECOVERY trial is made available.
Conditional recommendation against
- Do not routinely use dexamethasone to treat COVID-19 in children or adolescents who do not require oxygen.
* Interim awaiting complete reporting: Dexamethasone should still be used for other evidence-based indications in children or adolescents who have COVID-19. This recommendation will be revisited when more complete and detailed reporting of this comparison of the RECOVERY trial is made available.
ACEIs/ARBs in patients with COVID-19
Recommended
Steroids for people with asthma or COPD and COVID-19
The evidence base for the recommendation regarding steroids for people with asthma or COPD and COVID-19 has been updated with no change to the strength or direction of the recommendation.
Consensus recommendation
The Taskforce is continually monitoring research to update recommendations weekly as new evidence accumulates.
Five clinical flowcharts have been developed by the Taskforce to cover:
Changes to flowcharts this week reflect:
We are currently reviewing evidence to develop recommendations and flowcharts to guide practice in areas including:
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.
NPS MedicineWise
NPS MedicineWise has just published two new podcasts:
Cochrane