Maicon Falavigna1,2,3, Verônica Colpani1,4, Cinara Stein1, Luciano Cesar Pontes Azevedo5,6, Angela Maria Bagattini5,7, Gabriela Vilela de Brito8, José Miguel Chatkin9,10, Sergio Cimerman11,12, Mirian de Freitas Dal Ben Corradi5, Clovis Arns da Cunha12,13, Flávia Cordeiro de Medeiros8, Haliton Alves de Oliveira Junior8, Leandro Genehr Fritscher1,9, Marcelo Basso Gazzana14,15, Débora Dalmas Gräf1, Lays Pires Marra8, Jessica Yumi Matuoka9, Michelle Silva Nunes16, Daniela Vianna Pachito5,17, Cássia Garcia Moraes Pagano1, Patrícia do Carmo Silva Parreira8, Rachel Riera5,18, Amilton Silva19, Bruno de Melo Tavares19, Alexandre Prehn Zavascki20,21, Regis Goulart Rosa1, Felipe Dal-Pizzol22,23. 1. Hospital Moinhos de Vento, Porto Alegre, RS, Brasil. 2. Instituto para Avaliação de Tecnologia em Saúde, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil. 3. Department of Health Research Methods, Evidence, and Impact, McMaster University - Hamilton, Canadá. 4. Programa de Pós-Graduação em Ciências Médicas: Endocrinologia, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil. 5. Hospital Sírio-Libanês - São Paulo (SP), Brasil. 6. Disciplina de Emergências Clínicas, Universidade de São Paulo - São Paulo (SP), Brasil. 7. Programa de Pós-Graduação em Medicina Tropical e Saúde Pública, Universidade Federal de Goiás - Goiânia (GO), Brasil. 8. Centro Internacional de Pesquisa, Hospital Alemão Oswaldo Cruz - São Paulo (SP), Brasil. 9. Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre (RS), Brasil. 10. Sociedade Brasileira de Pneumologia e Tisiologia - Brasília (DF), Brasil. 11. Instituto de Infectologia Emílio Ribas - São Paulo (SP), Brasil. 12. Sociedade Brasileira de Infectologia - São Paulo (SP), Brasil. 13. Universidade Federal do Paraná - Curitiba (PR), Brasil. 14. Programa de Pós-Graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil. 15. Serviço de Pneumologia e Cirurgia Torácica, Hospital Moinhos de Vento - Porto Alegre (RS), Brasil. 16. Empresa Brasileira de Serviços Hospitalares - Brasília (DF), Brasil. 17. Fundação Getúlio Vargas - São Paulo (SP), Brasil. 18. Escola Paulista de Medicina, Universidade Federal de São Paulo - São Paulo (SP), Brasil. 19. Hospital Alemão Oswaldo Cruz - São Paulo (SP), Brasil. 20. Serviço de Infectologia e Controle de Infecção, Hospital Moinhos de Vento - Porto Alegre (RS), Brasil. 21. Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brasil. 22. Laboratório de Fisiopatologia Experimental, Programa de Pós-Graduação em Ciências da Saúde, Universidade do Extremo Sul Catarinense – Criciúma (SC), Brasil. 23. Serviço de Medicina Intensiva, Hospital São José - Criciúma (SC), Brasil
Abstract
INTRODUCTION: Different therapies are currently used, considered, or proposed for the treatment of COVID-19; for many of those therapies, no appropriate assessment of effectiveness and safety was performed. This document aims to provide scientifically available evidence-based information in a transparent interpretation, to subsidize decisions related to the pharmacological therapy of COVID-19 in Brazil. METHODS: A group of 27 experts and methodologists integrated a task-force formed by professionals from the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB), the Brazilian Society of Infectious Diseases (Sociedad Brasileira de Infectologia - SBI) and the Brazilian Society of Pulmonology and Tisiology (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT). Rapid systematic reviews, updated on April 28, 2020, were conducted. The assessment of the quality of evidence and the development of recommendations followed the GRADE system. The recommendations were written on May 5, 8, and 13, 2020. RESULTS: Eleven recommendations were issued based on low or very-low level evidence. We do not recommend the routine use of hydroxychloroquine, chloroquine, azithromycin, lopinavir/ritonavir, corticosteroids, or tocilizumab for the treatment of COVID-19. Prophylactic heparin should be used in hospitalized patients, however, no anticoagulation should be provided for patients without a specific clinical indication. Antibiotics and oseltamivir should only be considered for patients with suspected bacterial or influenza coinfection, respectively. CONCLUSION: So far no pharmacological intervention was proven effective and safe to warrant its use in the routine treatment of COVID-19 patients; therefore such patients should ideally be treated in the context of clinical trials. The recommendations herein provided will be revised continuously aiming to capture newly generated evidence.
INTRODUCTION: Different therapies are currently used, considered, or proposed for the treatment of COVID-19; for many of those therapies, no appropriate assessment of effectiveness and safety was performed. This document aims to provide scientifically available evidence-based information in a transparent interpretation, to subsidize decisions related to the pharmacological therapy of COVID-19 in Brazil. METHODS: A group of 27 experts and methodologists integrated a task-force formed by professionals from the Brazilian Association of Intensive Care Medicine (Associação de Medicina Intensiva Brasileira - AMIB), the Brazilian Society of Infectious Diseases (Sociedad Brasileira de Infectologia - SBI) and the Brazilian Society of Pulmonology and Tisiology (Sociedade Brasileira de Pneumologia e Tisiologia - SBPT). Rapid systematic reviews, updated on April 28, 2020, were conducted. The assessment of the quality of evidence and the development of recommendations followed the GRADE system. The recommendations were written on May 5, 8, and 13, 2020. RESULTS: Eleven recommendations were issued based on low or very-low level evidence. We do not recommend the routine use of hydroxychloroquine, chloroquine, azithromycin, lopinavir/ritonavir, corticosteroids, or tocilizumab for the treatment of COVID-19. Prophylactic heparin should be used in hospitalized patients, however, no anticoagulation should be provided for patients without a specific clinical indication. Antibiotics and oseltamivir should only be considered for patients with suspected bacterial or influenza coinfection, respectively. CONCLUSION: So far no pharmacological intervention was proven effective and safe to warrant its use in the routine treatment of COVID-19patients; therefore such patients should ideally be treated in the context of clinical trials. The recommendations herein provided will be revised continuously aiming to capture newly generated evidence.
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