Université de Sherbrooke, Centre de recherche due CHU de Sherbrooke, Sherbrooke, Quebec, Canada
Not guideline development group member; resource for methodology, systematic review, and content support
BMJ. 2021 Mar 1;372:n526. doi: 10.1136/bmj.n526.
What is the role of drugs in preventing covid-19? WHY DOES THIS MATTER?: There is widespread interest in whether drug interventions can be used for the prevention of covid-19, but there is uncertainty about which drugs, if any, are effective. The first version of this living guideline focuses on the evidence for hydroxychloroquine. Subsequent updates will cover other drugs being investigated for their role in the prevention of covid-19.
The guideline development panel made a strong recommendation against the use of hydroxychloroquine for individuals who do not have covid-19 (high certainty).
This living guideline is from the World Health Organization (WHO) and provides up to date covid-19 guidance to inform policy and practice worldwide. Magic Evidence Ecosystem Foundation (MAGIC) provided methodological support. A living systematic review with network analysis informed the recommendations. An international guideline development panel of content experts, clinicians, patients, an ethicist and methodologists produced recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
The linked systematic review and network meta-analysis (6 trials and 6059 participants) found that hydroxychloroquine had a small or no effect on mortality and admission to hospital (high certainty evidence). There was a small or no effect on laboratory confirmed SARS-CoV-2 infection (moderate certainty evidence) but probably increased adverse events leading to discontinuation (moderate certainty evidence). The panel judged that almost all people would not consider this drug worthwhile. In addition, the panel decided that contextual factors such as resources, feasibility, acceptability, and equity for countries and healthcare systems were unlikely to alter the recommendation. The panel considers that this drug is no longer a research priority and that resources should rather be oriented to evaluate other more promising drugs to prevent covid-19.
This is a living guideline. New recommendations will be published in this article and signposted by update notices to this guideline.
This is the first version of the living guideline for drugs to prevent covid-19. It complements the WHO living guideline on drugs to treat covid-19. When citing this article, please consider adding the update number and date of access for clarity.
药物在预防新冠病毒中的作用是什么？
人们广泛关注药物干预是否可用于预防新冠病毒，但对于哪些药物（如果有的话）有效存在不确定性。本实践指南的第一版重点关注羟氯喹的证据。随后的更新将涵盖正在研究用于预防新冠病毒的其他药物。
指南制定小组强烈建议不要将羟氯喹用于未感染新冠病毒的个体（高确定性）。
本实践指南由世界卫生组织（WHO）制定，为全球提供最新的新冠病毒防治指南，以指导政策和实践。Magic Evidence Ecosystem Foundation（MAGIC）提供了方法学支持。网络分析的实时系统评价为建议提供了信息。一个由内容专家、临床医生、患者、伦理学家和方法学家组成的国际指南制定小组，根据值得信赖的指南制定标准，采用推荐评估、制定与评价（GRADE）方法制定了建议。
相关系统评价和网络荟萃分析（6 项试验，6059 名参与者）发现，羟氯喹对死亡率和住院治疗的影响较小或无（高确定性证据）。对实验室确诊的 SARS-CoV-2 感染的影响较小或无（中等确定性证据），但可能增加导致停药的不良事件（中等确定性证据）。专家组认为，几乎所有人都不会认为这种药物值得使用。此外，专家组认为，各国和医疗体系的资源、可行性、可接受性和公平性等背景因素不太可能改变这一建议。专家组认为，这种药物不再是研究重点，而应将资源用于评估其他更有希望预防新冠病毒的药物。
这是一个实践指南。新的建议将在本文中发布，并通过更新通知对此指南进行标记。
这是预防新冠病毒药物实践指南的第一版。它补充了 WHO 关于治疗新冠病毒的药物实践指南。在引用本文时，请考虑添加更新编号和访问日期以明确说明。
