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01-02-2022 | Tocilizumab | Original Paper

Key summary of German national treatment guidance for hospitalized COVID-19 patients

Key pharmacologic recommendations from a national German living guideline using an Evidence to Decision Framework (last updated 17.05.2021)

Authors: Jakob J. Malin, Christoph D. Spinner, Uwe Janssens, Tobias Welte, Steffen Weber-Carstens, Gereon Schälte, Petra Gastmeier, Florian Langer, Martin Wepler, Michael Westhoff, Michael Pfeifer, Klaus F. Rabe, Florian Hoffmann, Bernd W. Böttiger, Julia Weinmann-Menke, Alexander Kersten, Peter Berlit, Marcin Krawczyk, Wiebke Nehls, Falk Fichtner, Sven Laudi, Miriam Stegemann, Nicole Skoetz, Monika Nothacker, Gernot Marx, Christian Karagiannidis, Stefan Kluge

Published in: Infection | Issue 1/2022

Abstract

Purpose

This executive summary of a national living guideline aims to provide rapid evidence based recommendations on the role of drug interventions in the treatment of hospitalized patients with COVID-19.

Methods

The guideline makes use of a systematic assessment and decision process using an evidence to decision framework (GRADE) as recommended standard WHO (2021). Recommendations are consented by an interdisciplinary panel. Evidence analysis and interpretation is supported by the CEOsys project providing extensive literature searches and living (meta-) analyses. For this executive summary, selected key recommendations on drug therapy are presented including the quality of the evidence and rationale for the level of recommendation.

Results

The guideline contains 11 key recommendations for COVID-19 drug therapy, eight of which are based on systematic review and/or meta-analysis, while three recommendations represent consensus expert opinion. Based on current evidence, the panel makes strong recommendations for corticosteroids (WHO scale 5–9) and prophylactic anticoagulation (all hospitalized patients with COVID-19) as standard of care. Intensified anticoagulation may be considered for patients with additional risk factors for venous thromboembolisms (VTE) and a low bleeding risk. The IL-6 antagonist tocilizumab may be added in case of high supplemental oxygen requirement and progressive disease (WHO scale 5–6). Treatment with nMABs may be considered for selected inpatients with an early SARS-CoV-2 infection that are not hospitalized for COVID-19. Convalescent plasma, azithromycin, ivermectin or vitamin D₃ should not be used in COVID-19 routine care.

Conclusion

For COVID-19 drug therapy, there are several options that are sufficiently supported by evidence. The living guidance will be updated as new evidence emerges.

Available only for authorised users

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Title: Key summary of German national treatment guidance for hospitalized COVID-19 patients
Key pharmacologic recommendations from a national German living guideline using an Evidence to Decision Framework (last updated 17.05.2021)
Authors: Jakob J. Malin
Christoph D. Spinner
Uwe Janssens
Tobias Welte
Steffen Weber-Carstens
Gereon Schälte
Petra Gastmeier
Florian Langer
Martin Wepler
Michael Westhoff
Michael Pfeifer
Klaus F. Rabe
Florian Hoffmann
Bernd W. Böttiger
Julia Weinmann-Menke
Alexander Kersten
Peter Berlit
Marcin Krawczyk
Wiebke Nehls
Falk Fichtner
Sven Laudi
Miriam Stegemann
Nicole Skoetz
Monika Nothacker
Gernot Marx
Christian Karagiannidis
Stefan Kluge
Publication date: 01-02-2022
Publisher: Springer Berlin Heidelberg
Keywords: Tocilizumab
Azithromycin
SARS-CoV-2
COVID-19
Ivermectin
Published in: Infection / Issue 1/2022
Print ISSN: 0300-8126
Electronic ISSN: 1439-0973
DOI: https://doi.org/10.1007/s15010-021-01645-2

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