Kazuma Yamakawa1, Ryo Yamamoto2, Takero Terayama3, Hideki Hashimoto4, Tadashi Ishihara5, Go Ishimaru6, Haruki Imura7,8, Hiromu Okano9, Chihiro Narita10, Takuya Mayumi11, Hideto Yasuda12, Kohei Yamada13, Hiroyuki Yamada14, Tatsuya Kawasaki15, Nobuaki Shime16, Kent Doi17, Moritoki Egi18, Hiroshi Ogura19, Morio Aihara20, Shigeki Kushimoto21, Osamu Nishida22. 1. Department of Emergency and Critical Care Medicine Osaka Medical and Pharmaceutical University Takatsuki Japan. 2. Department of Emergency and Critical Care Medicine Keio University School of Medicine Tokyo Japan. 3. Department of Psychiatry, School of Medicine National Defense Medical College Tokorozawa Japan. 4. Department of Infectious Diseases The University of Tokyo Hospital Tokyo Japan. 5. Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Japan. 6. Department of General Internal Medicine Soka Municipal Hospital Soka Japan. 7. Department of Infectious Diseases, Rakuwakai Otowa Hospital Kyoto University Kyoto Japan. 8. Department of Health Informatics, School of Public Health Kyoto University Kyoto Japan. 9. Department of Critical Care and Emergency Medicine National Hospital Organization Yokohama Medical Center Yokohama Japan. 10. Department of Emergency Medicine and Intensive Care Medicine Shizuoka General Hospital Shizuoka Japan. 11. Department of Internal Medicine Kanazawa Municipal Hospital Kanazawa Japan. 12. Department of Emergency and Critical Care Medicine Jichi Medical University Saitama Medical Center Saitama Japan. 13. Department of Traumatology and Critical Care Medicine National Defense Medical College Tokorozawa Japan. 14. Department of Primary Care and Emergency Medicine Kyoto University Hospital Kyoto Japan. 15. Department of Pediatric Critical Care Shizuoka Children's Hospital Shizuoka Japan. 16. Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan. 17. Department of Emergency and Critical Care Medicine, Graduate School of Medicine The University of Tokyo Tokyo Japan. 18. Department of Anesthesia Kyoto University Hospital Kyoto Japan. 19. Department of Traumatology and Acute Critical Medicine Osaka University Medical School Suita Japan. 20. Department of Gastroenterology and Hematology Hirosaki University Graduate School of Medicine Hirosaki Japan. 21. Division of Emergency and Critical Care Medicine Tohoku University Graduate School of Medicine Sendai Japan. 22. Department of Anesthesiology and Critical Care Medicine Fujita Health University School of Medicine Toyoake Japan.
Abstract
Background: 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. Methods: 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). Recommendations: 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.
Background: 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. Methods: 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). Recommendations: 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.
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