Division of Infectious Diseases, Houston Methodist Hospital, Houston, Texas, USA.
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Clin Infect Dis. 2024 Jun 27;78(7):e250-e349. doi: 10.1093/cid/ciac724.
There are many pharmacologic therapies that are being used or considered for treatment of coronavirus disease 2019 (COVID-19), with rapidly changing efficacy and safety evidence from trials. The objective was to develop evidence-based, rapid, living guidelines intended to support patients, clinicians, and other healthcare professionals in their decisions about treatment and management of patients with COVID-19. In March 2020, the Infectious Diseases Society of America (IDSA) formed a multidisciplinary guideline panel of infectious disease clinicians, pharmacists, and methodologists with varied areas of expertise to regularly review the evidence and make recommendations about the treatment and management of persons with COVID-19. The process used a living guideline approach and followed a rapid recommendation development checklist. The panel prioritized questions and outcomes. A systematic review of the peer-reviewed and grey literature was conducted at regular intervals. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations. Based on the most recent search conducted on 31 May 2022, the IDSA guideline panel has made 32 recommendations for the treatment and management of the following groups/populations: pre- and postexposure prophylaxis, ambulatory with mild-to-moderate disease, and hospitalized with mild-to-moderate, severe but not critical, and critical disease. As these are living guidelines, the most recent recommendations can be found online at: https://idsociety.org/COVID19guidelines. At the inception of its work, the panel has expressed the overarching goal that patients be recruited into ongoing trials. Since then, many trials were conducted that provided much-needed evidence for COVID-19 therapies. There still remain many unanswered questions as the pandemic evolved, which we hope future trials can answer.
有许多药理学疗法被用于或被考虑用于治疗 2019 年冠状病毒病（COVID-19），临床试验中的疗效和安全性证据不断变化。本研究的目的是制定基于证据的、快速的、实时的指南，以支持患者、临床医生和其他医疗保健专业人员在治疗和管理 COVID-19 患者方面做出决策。2020 年 3 月，美国传染病学会（IDSA）组建了一个由传染病临床医生、药剂师和方法学家组成的多学科指南小组，他们具有不同的专业领域，负责定期审查证据，并就 COVID-19 患者的治疗和管理提出建议。该过程使用实时指南方法，并遵循快速推荐制定清单。专家组确定了问题和结果的优先级。定期对同行评议文献和灰色文献进行系统综述。使用推荐评估、制定与评估（GRADE）方法评估证据的确定性并提出建议。基于 2022 年 5 月 31 日进行的最新搜索，IDSA 指南小组针对以下群体/人群的治疗和管理提出了 32 项建议：暴露前和暴露后预防、门诊轻度至中度疾病、住院轻度至中度、严重但非危急和危急疾病。由于这些是实时指南，因此可以在以下网址找到最新的建议：https://idsociety.org/COVID19guidelines。在开展工作之初，专家组就表示了首要目标，即让患者参与正在进行的试验。从那时起，许多试验为 COVID-19 治疗提供了急需的证据。随着大流行的发展，仍有许多问题尚未得到解答，我们希望未来的试验能够回答这些问题。
