DGI recommendations for COVID-19 pharmacotherapy
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CORRESPONDENCE
DGI recommendations for COVID‑19 pharmacotherapy Jakob J. Malin1,2 · Christoph D. Spinner3 · German Society of Infectious Diseases (DGI) Received: 18 August 2020 / Accepted: 21 August 2020 © The Author(s) 2020
German Society for Infectious Diseases (DGI) recommendations for COVID-19 pharmacotherapy Last updated: 19.08.2020 Mild-moderate disease Symptoms of a lower respiratory tract infection No oxygen support required Severe disease Oxygen support required (oxygen saturation ≤ 94% on room air)
Critical disease Hypoxic respiratory failure Invasive/non-invasive ventilation High-flow oxygen therapy
No specific therapy recommendeda
Dexamethasoneb,c,d plus Remdesivire,f,g
6 mg/day per OS or intravenous for up to 10 days Day 1: 200 mg intravenous loading dose Day 2–5: 100 mg intravenous per day maintenance dose Duration: 5 days, consider extension to maximal 10 d aysh There are no clinical data on combination therapy with remdesivir and dexamethasone available Dexamethasoneb,i 6 mg per day intravenous for up to 10 days Day 1: 200 mg intravenous (loading dose) plus Day 2–5 (10): 100 mg intravenous per day (maintenance Remdesivire,j dose) Duration: 5–10 d aysh There are no clinical data on combination therapy with remdesivir and dexamethasone available
CI confidence interval a
Current evidence supporting the use of remdesivir in patients with mild or moderate COVID-19 (no oxygen therapy required) [1] is insufficient
b c
Off-label-use based upon preliminary results from the RECOVERY trial [2]
Reduced 28-day-mortality by one-fifth in patients that require oxygen therapy (in this study oxygen saturation 92–94% on room air) without invasive ventilation [23.3% vs. 26.2%; rate ratio (RR) 0.82 (95% CI 0.72-0.94)] [2]
d The clinical benefit of dexamethasone demonstrated in the RECOVERY trial was plainest in patients being treated after 7 days from symptom onset [2] e
Conditional European authorization for patients with COVID-19 pneumonia (≥ 12 years, weighing ≥ 40 kg) that require oxygen support and have an estimated glomerular filtration rate (eGFR) > 30 ml/min [3]; When applied, close monitoring of biochemical markers for organ toxicity (in particular hepatotoxicity) is mandatory. Adverse events must be reported immediately to the Federal Institute for Drugs and Medical Devices (humanweb.pei.de) and the manufacturer Gilead Sciences. Remdesivir should be administered as intravenous infusion over 30–60 min [4]
f
The clinical benefit of remdesivir has been demonstrated in the Adaptive COVID-19 Treatment Trial (ACTT-1 trial) irrespective of the duration of illness. The time from symptom onset to study enrollment was 6–12 days (median 9) [1]. Subgroup analyses of a previous trial showed a numerical reduction in time to recovery of median 5 days only in patients that were treated within 10 days after symptom onset [hazard ratio 1.52 (95% CI 0.95–2.43)] [5]. Results from a macaque model of SARS-CoV-2 infection also support the use of remdesivir in an early phase of disease [6]
Jakob J. Malin an
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