We provide interim support on the appropriate use of investigational medicines for the treatment and prevention of COVID-19.
Our aim is to bring together the best available evidence, and the latest on clinical trial development, to support hospital healthcare professionals when considering available treatment options for patients with COVID-19.
Medical management of hospitalised adults with COVID-19 and available RCTs
1 Patients should ideally have laboratory confirmed SARSCoV-2 infection. In the absence of a confirmed virological diagnosis, a multidisciplinary team should have a high level of confidence that the clinical and radiological features suggest that COVID-19 is the most likely diagnosis ( CTAG antivirals position statement; 2.6.1) 2 Dexamethasone 6 mg daily for 10 days (orally or intravenously) or until discharge from hospital. In pregnancy or breastfeeding women, prednisolone 40 mg administered by mouth (or intravenous hydrocortisone 80 mg twice daily) should be used instead of dexamethasone. See CMO letter for full details. 3 Remdesivir 200mg intravenously on Day 1 followed by 100mg intravenously until Day 5, can be continued to Day 10. Remdesivir should not be used in patients with eGFR < 30mL/min or ALT levels > 5 times the upper limit of normal at baseline. Check SPC for full cautions and contraindications. 4 There is no interaction of remdesivir and dexamathasone expected ( NHSE Interim Clinical Commissioning Policy) ( University of Liverpool interaction checker) 5 CTAG are of the opinion that remdesivir is unlikely to improve clinical outcome in people who appear clinically to be in the recovery phase of the illness, or those who have required mechanical ventilation or ECMO for a number of days and do not have ongoing evidence of high viral burden or ongoing viral replication, nor have advanced immunosuppression that may put them at risk of reactivation ( CTAG antivirals position statement; 2.6.1) 6 NHSE Interim Clinical Commissioning Policy states that in times of limited supply additional criteria will be necessary in order to allocate remdesivir to those with the greatest capacity to benefit. In this context the following criteria must also be met: – At the time of decision to treat with remdesivir patients should not be receiving ongoing mechanical ventilation or ECMO. Patients presenting with an initial rapid deterioration can however, be considered for treatment with remdesivir. – Multi-disciplinary team assessments should determine if patients not suitable for escalation would benefit from initiation of treatment with remdesivir. – If patients on remdesivir require escalation, continuation of the drugs should be considered by multi-disciplinary team assessment.
(v1.0; 20 July 2020)