Yamakawa Kazuma, Yamamoto Ryo, Terayama Takero, Hashimoto Hideki, Ishihara Tadashi, Ishimaru Go, Imura Haruki, Okano Hiromu, Narita Chihiro, Mayumi Takuya, Yasuda Hideto, Yamada Kohei, Yamada Hiroyuki, Kawasaki Tatsuya, Shime Nobuaki, Doi Kent, Egi Moritoki, Ogura Hiroshi, Aihara Morio, Kushimoto Shigeki, Nishida Osamu
Department of Emergency Medicine Osaka Medical and Pharmaceutical University Takatsuki Japan.
Department of Emergency and Critical Care Medicine Keio University School of Medicine Tokyo Japan.
Acute Med Surg. 2021 Nov 16;8(1):e706. doi: 10.1002/ams2.706. eCollection 2021 Jan-Dec.
The coronavirus disease 2019 (COVID-19) has spread worldwide since early 2020, and there are still no signs of resolution. The Japanese Clinical Practice Guidelines for the Management of Sepsis and Septic Shock (J-SSCG) 2020 Special Committee created the Japanese rapid/living recommendations on drug management for COVID-19 using the experience of creating the J-SSCG.
The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to determine the certainty of the evidence and strength of the recommendations. The first edition of this guideline was released on September 9, 2020, and this document is the revised edition (version 4.0; released on September 9, 2021). Clinical questions (CQs) were set for the following seven drugs: favipiravir (CQ1), remdesivir (CQ2), corticosteroids (CQ4), tocilizumab (CQ5), anticoagulants (CQ7), baricitinib (CQ8), and casirivimab/imdevimab (CQ9). Two CQs (hydroxychloroquine [CQ3] and ciclesonide [CQ6]) were retrieved in this updated version.
Favipiravir is not suggested for all patients with COVID-19 (GRADE 2C). Remdesivir is suggested for patients with moderate COVID-19 requiring supplemental oxygen/hospitalization (GRADE 2B). Corticosteroids are recommended for patients with moderate COVID-19 requiring supplemental oxygen/hospitalization (GRADE 1B) and for patients with severe COVID-19 requiring mechanical ventilation/intensive care (GRADE 1A); however, their administration is not recommended for patients with mild COVID-19 not requiring supplemental oxygen (GRADE 1B). Tocilizumab is suggested for patients with moderate COVID-19 requiring supplemental oxygen/hospitalization (GRADE 2B). Anticoagulant administration is recommended for patients with moderate COVID-19 requiring supplemental oxygen/hospitalization and patients with severe COVID-19 requiring mechanical ventilation/intensive care (good practice statement). Baricitinib is suggested for patients with moderate COVID-19 requiring supplemental oxygen/hospitalization (GRADE 2C). Casirivimab/imdevimab is recommended for patients with mild COVID-19 not requiring supplemental oxygen (GRADE 1B). We hope that these updated clinical practice guidelines will help medical professionals involved in the care of patients with COVID-19.
2019年冠状病毒病（COVID-19）自2020年初在全球蔓延，目前仍无缓解迹象。日本脓毒症和脓毒性休克管理临床实践指南（J-SSCG）2020特别委员会利用制定J-SSCG的经验，制定了关于COVID-19药物管理的日本快速/实用建议。
采用推荐分级、评估、制定和评价（GRADE）方法来确定证据的确定性和建议的强度。本指南第一版于2020年9月9日发布，本文档为修订版（第4.0版；于2021年9月9日发布）。针对以下七种药物设置了临床问题（CQ）：法匹拉韦（CQ1）、瑞德西韦（CQ2）、皮质类固醇（CQ4）、托珠单抗（CQ5）、抗凝剂（CQ7）、巴瑞替尼（CQ8）和卡西瑞韦单抗/英地西韦单抗（CQ9）。在本次更新版本中检索到了两个临床问题（羟氯喹啉[CQ3]和环索奈德[CQ6]）。
不建议将法匹拉韦用于所有COVID-19患者（证据等级2C）。建议将瑞德西韦用于需要补充氧气/住院治疗的中度COVID-19患者（证据等级2B）。建议将皮质类固醇用于需要补充氧气/住院治疗的中度COVID-19患者（证据等级1B）以及需要机械通气/重症监护的重度COVID-19患者（证据等级1A）；然而，不建议将其用于不需要补充氧气的轻度COVID-19患者（证据等级1B）。建议将托珠单抗用于需要补充氧气/住院治疗的中度COVID-19患者（证据等级2B）。建议对需要补充氧气/住院治疗的中度COVID-19患者以及需要机械通气/重症监护的重度COVID-19患者使用抗凝剂（良好实践声明）。建议将巴瑞替尼用于需要补充氧气/住院治疗的中度COVID-19患者（证据等级2C）。建议将卡西瑞韦单抗/英地西韦单抗用于不需要补充氧气的轻度COVID-19患者（证据等级1B）。我们希望这些更新后的临床实践指南将有助于参与COVID-19患者护理的医学专业人员。
