Naslov
COVID-19: Treatment guidelines in real-life

Autori
Papić, Neven

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Skup
3rd South-East European Conference on Travel, Tropical, Migration Medicine and HIV and 4th Croatian Congress on Travel, Tropical, Migration Medicine & HIV

Mjesto i datum
Zadar, Hrvatska, 16.09.2021. - 19.09.2021

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Domaća recenzija

Ključne riječi
COVID-19 ; guidelines

Sažetak
SARS-CoV-2 (COVID-19) has been changing the face of medicine since December 2019, with unprecedented number of studies published during the shortest period. As we navigate through COVID- 19 treatment guidelines, we should be aware of limitations and quality of published data. Currently, there are three pillars of COVID-19 treatment: (1) antivirals (remdesivir), (2) immunomodulators (corticosteroids and IL6 antagonists) and (3) anticoagulants (low-molecular weight heparin). While remdesivir was associated with improved time to recovery in patients who required low oxygen supplementation (but not HFNC, NIV or MV) in registration studies, open-label trials showed no mortality benefit. Currently, remdesivir is recommended for patients requiring minimal oxygen supplementation and has the highest efficacy when used early in the course of disease. The published guidelines are inconsistent in recommendations of timing, choice, dosage, and duration of corticosteroid therapy. While most data support low dose dexamethasone in patients requiring oxygen supplementation, higher dosages of dexamethasone or methylprednisolone did not show beneficial effect, and there are concerns that might be associated with higher risk of nosocomial infections and increased risk of pulmonary thromboembolism. Notably, dexamethasone should not be used in patients not requiring oxygen supplementation. The critical selection of patients who might benefit tocilizumab therapy is crucial, with the primary goal in stopping disease progression (need for mechanical ventilation or ICU admission). Therefore, it is indicated in recently hospitalized patients who are exhibiting rapid respiratory decompensation and have increased markers of inflammation. Due to the high prevalence of pulmonary thromboembolism and favorable outcomes shown in large studies, hospitalizes patients should receive prophylactic dose LMWH anticoagulation. Currently it is unclear which patients might benefit from therapeutic dose anticoagulation. In outpatients, anticoagulants and antiplatelet therapy should not be initiated unless the patient has other indications. Monoclonal antibodies (casirivimab plus imdevimab ; or sotrovimab) can be used to treat outpatients with mild to moderate COVID-19 who are at high risk of clinical progression regardless of previous vaccination. In general, they should not be used to treat hospitalized patients. However, there are many exceptions not covered in guidelines, such as immunocompromised patients, patients with prolonged fever without need for O2 supplementation, morbidly obese patients, or immunocompetent patients with prolonged viremia. Therefore, treatment should be individualized keeping in mind potential benefits and risks. Finally, we need better treatment options for critically ill patients.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA