Apprising the need for a living guideline approach in the COVID-19 era.

Dear Editor,

The sheer pace of the global crisis emanating as a consequence of the coronavirus disease 2019 (COVID-19) pandemic has jolted the scientific community. Amidst a concerted research endeavor put forth by the scientific powerhouse, the COVID-19 related research has been accompanied by ardent debates regarding its reliability, robustness, and reproducibility.[1] While the real-time research challenges are understandably intensified in the view of a condensed time frame in an ongoing pandemic, the task of efficiently adapting to a rapidly evolving global situation has proven to be equally daunting for the clinical societies and regulatory bodies.[1]

Appropriate to the context, the pandemic times have motivated the interest of the guideline developers in the living guideline approach.[2] Defined as “an optimization of the guideline development process to allow updating of individual recommendations as soon as new relevant evidence becomes available,” the approach aims at the timely provision of trustworthy, evidence-based, decision-making advice for clinicians.[3] Alongside a development process adhering to high quality standards, the dynamic update of the individual recommendations is likely to add an incremental value.

Exemplified by the World Health Organisation’s (WHO) recommendations on maternal and perinatal health, the living guideline approach captivates an enhanced attention for being peculiarly responsive to the emerging evidence.[4] A pandemic situation best heralds the need of a living guideline approach for a range of factors as enlisted in Table 1. Vandvik and colleagues[5] propose that employing the former can assist in fixing the cracks in the COVID-19 evidence pipeline.

Table 1

Factors propounding the need for living guidelines in COVID-19[12345]

High prevalence of an unprecedented global disease Unanticipated complications, morbidity-mortality Heterogeneous practices, requirement of standardization Colossal research magnitude, including preprints Developing pragmatic preventive-diagnostic-therapeutic strategies Assisting bench-to-bedside translation, practical decision-making Dynamic outlook towards an evolving health problem Future preparedness

This evidence-informed dynamic approach can function smoothly in the background of a meticulous literature monitoring, subsequent updating of systematic reviews for evidence synthesis, consultative prioritization procedure, and living guideline panels’ electronic consultations.[34] Herein, the recent research experience in COVID-19 is encouraging with respect to the dynamic update of a comprehensive set of recommendations based on living systematic reviews (LSR) and network meta-analysis published in scientific journals and those published as the Cochrane collaboration.[25] This is further assisted with the advent of artificial intelligence. The presence of structured data on interoperable user-friendly platforms such as MAGICapp allows for global dissemination of multilayered recommendations, interactive evidence synopsis, and decision-making aids. The pre-eminent guideline developing organizations like the WHO has come up with living guidelines on the prevention and treatment of COVID-19.[25]

Nevertheless, the transition towards a living guideline approach can only be successful and sustainable when backed by an augmented workflow of appropriate LSRs and an improved collaboration between the LSRs and living guideline teams. At the same time, the requirement of a significant capital, the need to minimize time-frame attributable to peer-reviews, defining thresholds for updating the recommendations and unified set of publication and dissemination procedure, necessitate simultaneous consideration.[3]

Amidst the present aim of optimizing programmes-practices and consolidating response to an evolving health crisis, the COVID-19 era reasonably apprises the need for the individual recommendations being continually updated, ahead of the thematic guidelines.[5] However, in a larger perspective, there is a potential need to foster a sound comprehension of the feasibility, productivity, validity, and impact of the living guideline approach on the evidence ecosystem, particularly prompted by the ever-intensifying research challenges.[15]

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Conflicts of interest

There are no conflicts of interest.