Download the Position Statement 
(v6.3; 24 December 2020)
Key messages
- Remdesivir (NHS stock) should only be offered to patients in line with the ‘Eligibility criteria’ as outlined in the UK interim Clinical Commissioning Policy for remdesvir. Patients receiving remdesivir should be reassessed and reviewed daily (see pragmatic ‘Reassessment and review’ criteria within the Commissioning Policy).
- Co-administration of dexmathasone or hydrocortisone is recommended for patients with critical or severe COVID-19, or those requiring supplemental oxygen to maintain target saturation – see CTAG treatment pathway
- Hospitals managing COVID-19 cases should make every effort to enrol COVID-19 patients in national priority clinical trials
- Suspected side effects to medicines used in coronavirus treatment should be reported via the Yellow Card COVID-19 reporting site: https://coronavirus-yellowcard.mhra.gov.uk/
Provenance
CTAG acts as a formal advisory group to the Royal College of Physicians and this position statement is endorsed by:
- British Infection association
- British Pharmacological Society
- UK Clinical Pharmacy Association – Pharmacy Infection Network
The CTAG Antivirals subgroup originally involved Infectious Diseases and Virology specialists from the High Consequence Infectious Diseases (HCID) Network, and subsequently expanded to include multidisciplinary representation from non-HCID NHS Providers.
Archives
| Date published | Version | Amendment |
|---|---|---|
| 23 March 2020 | 1.0 | New document |
| 23 Mar 2020 | 1.1 | Updated Gilead remdesivir Compassionate Use Programme eligibility criteria |
| 27 March 2020 | 1.2 | Added NHS England and NHS Improvement speciality guide for patient management. Added MHRA advice on chloroquine and hydroxychloroquine. Added hydroxychloroquine arm of RECOVERY study; added link to NIHR website. |
| 01 April 2020 | 2.0 | Updated evidence summaries in Appendix 1 (new trials for lopinavir/ritonavir and chloroquine). Merged ‘Position statement’ and ‘Decision Support Tool’ into a single document. Updated Section 3 with new trials. Updated Figure 1 with relationship between RECOVERY and PRINCIPLE/REMAP-CAP. |
| 07 April 2020 | 2.1 | Updated title to reflect updated scope (antiviral use in hospitals). Updated Section 2, 3 and Figure 1 with new trials and trial status. Included reference to CMO letter. Reformatting throughout. Added BIA and UKCPA-PIN logos (with permission). |
| 08 April 2020 | 2.2 | Updated membership & provenance. Corrected typo (2.5). |
| 18 April 2020 | 2.3 | Updated arms of RECOVERY study. Provided additional information for Gilead remdesivir Compassionate Use Programme. Updated references and web links. Updated evidence summaries in Appendix 1. Added azithromycin and inhaled interferon tables to Appendix 1. |
| 01 May 2020 | 2.4 | Addition of ‘Key messages’ and ‘Abbreviations’. Emphasised importance of avoiding off-label use of investigational antivirals. Added reference to ‘CTAG: Position Statement on the use of investigational immunomodulatory agents for COVID-19 in adults’. Format change to clinical trials tables. Change SNG016 and COPCOV from ‘proposed’ to ‘active’. Added GenOMICC study. Updated evidence summaries in Appendix 1 (remdesivir; nebulised interferon; added EMA statement for chloroquine/hydroxychloroquine). |
| 22 May 2020 | 2.5 | Included reference to CMO letter and COVID-19 Yellow Card reporting. Updated evidence summaries in Appendix 1 (interferon). Updated support for patients diagnosed with COVID-19 whilst receiving investigative prophylactic treatment. Removed reference to GenOMICC as out of scope. Updated RECOVERY eligibility criteria to include paediatrics. Changed COPCOV from chloroquine to hydroxychloroquine. Changed CROWN CORONATION from hydroxychloroquine to chloroquine. Removed DisCoVeRy from Table 2. |
| 06 June 2020 | 3.0 | Included unlicensed remdesivir EAMS scheme and NHS implementation plan for that scheme; updated Section 2 accordingly and added a new monograph (Section 5). Moved studies ACTT-1, 5773, 5774 and SNG016 into a new ‘Closed to recruitment’ table. Updated evidence summaries in Appendix 1 (remdesivir; chloroquine/hydroxychloroquine). |
| 12 June 2020 | 3.1 | Updated NHS implementation plan for EAMS. Updated evidence summaries in Appendix 1 (remdesivir; chloroquine/hydroxychloroquine). |
| 29 June 2020 | 3.2 | Made reference to RECOVERY dexamethasone results. Added CTAG advice on the use of remdesivir. Updated arms of PRICIPLE study. Updated evidence summaries in Appendix 1 (systemic interferon; convalescent plasma). |
| 03 July 2020 | 3.3 | Moved ACCORD-2 to ‘Active studies’ table. Added discontinued arms of RECOVERY to ‘Closed to recruitment’ table. Updated evidence summaries in Appendix 1 (lopinavir/ritonavir). |
| 10 July 2020 | 4.0 | Updated with information on conditional marketing authorisation for remdesivir; EAMS programme lapsed so references removed. |
| 18 August 2020 | 4.1 | Reformatting throughout. Updated evidence summaries in Appendix 1 (chloroquine / hydroxychloroquine, azithromycin, interferon (nebulised), convalescent plasma). |
| 15 October 2020 | 5.0 | Updated to reflect supply restrictions to remdesivir. Removed summary of individual trials. Removed prophylaxis chapter as out of scope. Updated all evidence summaries in Appendix 1. |
| 05 December 2020 | 6.0 | Simplified position statement (removed monographs x 2 and signposting to relevant trials). |
| 06 December 2020 | 6.1 | Added SOLIDARITY NEJM publication |
| 07 December 2020 | 6.2 | Updated pregnancy and breastfeeding advice |