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 and Critical Care 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. 2022 Oct 19;9(1):e789. doi: 10.1002/ams2.789. eCollection 2022 Jan-Dec.
Coronavirus disease (COVID-19), an infectious disease caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 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 recommendations. The first edition of this guideline was released on September 9, 2020, and this is the revised edition (version 5.0; released on July 15, 2022). Clinical questions (CQs) were set for the following 10 drugs: favipiravir (CQ1), remdesivir (CQ2), corticosteroids (CQ4), tocilizumab (CQ5), anticoagulants (CQ7), baricitinib (CQ8), casirivimab/imdevimab (CQ9-1), sotrovimab (CQ9-2), molnupiravir (CQ10), and nirmatrelvir/ritonavir (CQ11).
Favipiravir is not suggested for all patients with COVID-19 (GRADE 2C). Remdesivir is suggested for patients with mild COVID-19 who do not require oxygen, and patients with moderate COVID-19 requiring supplemental oxygen/hospitalization (both GRADE 2B). Corticosteroids are recommended for moderate and severe COVID-19 (GRADE 1B, 1A). However, their administration is not recommended for mild COVID-19 (GRADE 1B). Tocilizumab is suggested for moderate and severe COVID-19 (GRADE 2B, 2C). Anticoagulant administration is recommended for moderate and severe COVID-19 (Good Practice Statement). Baricitinib is suggested for moderate and severe COVID-19 (both GRADE 2C). Casirivimab/imdevimab and sotrovimab are recommended for mild COVID-19 (both GRADE 2C). Molnupiravir and nirmatrelvir/ritonavir are recommended for mild COVID-19 (both GRADE 2C). SARS-CoV-2 mutant strains emerge occasionally, and each time, the treatment policy at clinics is forced to change drastically. We ask health-care professionals in the field to refer to the recommendations in these guidelines and use these to keep up to date with COVID-19 epidemiological information.
冠状病毒病（COVID-19）是由新型冠状病毒严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的一种传染病，自2020年初以来已在全球范围内传播，目前仍没有缓解的迹象。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推荐的强度。本指南的第一版于2020年9月9日发布，这是修订版（第5.0版；于2022年7月15日发布）。针对以下10种药物设定了临床问题（CQs）：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）、卡西瑞单抗/伊德维单抗（CQ9-1）、索托维单抗（CQ9-2）、莫努匹拉韦（CQ10）和奈玛特韦/利托那韦（CQ11）。
不建议将法匹拉韦用于所有COVID-19患者（推荐等级2C）。对于不需要吸氧的轻度COVID-19患者以及需要补充氧气/住院治疗的中度COVID-19患者，建议使用瑞德西韦（均为推荐等级2B）。对于中度和重度COVID-患者，推荐使用皮质类固醇（推荐等级1B、1A）。然而，不建议将其用于轻度COVID-19患者（推荐等级1B）。对于中度和重度COVID-19患者，建议使用托珠单抗（推荐等级2B、2C）。对于中度和重度COVID-19患者，建议使用抗凝剂（良好实践声明）。对于中度和重度COVID-19患者，建议使用巴瑞替尼（均为推荐等级2C）。对于轻度COVID-19患者，推荐使用卡西瑞单抗/伊德维单抗和索托维单抗（均为推荐等级2C）。对于轻度COVID-19患者，推荐使用莫努匹拉韦和奈玛特韦/利托那韦（均为推荐等级2C）。SARS-CoV-2突变株偶尔出现，每次出现时，临床的治疗策略都被迫大幅改变。我们要求该领域医护人员参考这些指南中的建议，并利用这些建议来及时了解COVID-19的流行病学信息。
