I have written previously about repurposed drugs being used for Covid 19. The most recent candidates where colchicine and fluvoxamine. According to the NIH, there is not enough information to recommend using them. This is not surprising as the studies were small. Here is a summary of the recommendations from the last issue of Physician’s First Watch which is ceasing publication today. Following that are the recommendations from the National Institute of Health.
NIH Updates COVID-19 Treatment Guidelines
By Kelly Young
Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS
The National Institutes of Health has made significant updates to its guidelines on treating people with COVID-19. Among the changes:
- There is not enough evidence to recommend for or against the use of colchicine in nonhospitalized patients. For hospitalized patients, colchicine is not recommended.
- There is not enough evidence to make a recommendation for or against use of fluvoxamine.
- The guidelines include information on variants of concern and their in vitro susceptibility to various monoclonal antibodies.
- The document also includes a new section on screening, triaging, and managing patients with mild-to-moderate COVID-19.
What’s New in the Guidelines
Last Updated: April 21, 2021
The Coronavirus Disease 2019 (COVID-19) Treatment Guidelines is published in an electronic format that can be updated in step with the rapid pace and growing volume of information regarding the treatment of COVID-19.
The COVID-19 Treatment Guidelines Panel (the Panel) is committed to updating this document to ensure that health care providers, patients, and policy experts have the most recent information regarding the optimal management of COVID-19 (see the Panel Roster for a list of Panel members).
New Guidelines sections and recommendations and updates to existing Guidelines sections are developed by working groups of Panel members. All recommendations included in the Guidelines are endorsed by a majority of Panel members (see the Introduction for additional details on the Guidelines development process).
Major revisions to the Guidelines within the last month are as follows:
April 21, 2021
New Sections of the Guidelines
Outpatient Management of Acute COVID-19
In this section, the Panel provides recommendations for screening, triage, and therapeutic management of patients with mild to moderate COVID-19 who do not require hospitalization. This section also provides recommendations for managing patients with COVID-19 after they are discharged from the emergency department or the hospital.
Based on the results of a large, randomized, placebo-controlled trial in outpatients with COVID-19, the Panel has determined that there are insufficient data to recommend either for or against the use of colchicine in nonhospitalized patients with COVID-19. The Panel recommends against the use of colchicine in hospitalized patients, except in a clinical trial (AIII).
Based on the results of a small randomized controlled trial and an observational study, the Panel has determined that there are insufficient data to recommend either for or against the use of fluvoxamine for the treatment of COVID-19.
Key Updates to the Guidelines
Therapeutic Management of Adults With COVID-19
This section has been updated to incorporate recommendations for when to use combination anti-SARS-CoV-2 monoclonal antibodies and tocilizumab (in combination with dexamethasone) in certain patients with COVID-19. This section also includes a detailed discussion of the rationale behind these recommendations.
Overview of COVID-19
A new subsection has been added to discuss the emerging information on SARS-CoV-2 variants of concern.
Clinical Spectrum of SARS-CoV-2 Infection
A new subsection describes reports of SARS-CoV-2 reinfection in individuals who had previously documented COVID-19. The discussion on patients who experience persistent symptoms or organ dysfunction after acute COVID-19 has also been updated.
Anti-SARS-CoV-2 Monoclonal Antibodies
This section now incorporates information and recommendations from the Panel’s Statement on the Emergency Use Authorization of Anti-SARS-CoV-2 Monoclonal Antibodies for the Treatment of COVID-19 that was released on April 8, 2021. This section also includes information on the various reported SARS-CoV-2 variants and the potential impact of mutations on in vitro susceptibility to different anti-SARS-CoV-2 monoclonal antibodies.
High-titer convalescent plasma is available through a Food and Drug Administration Emergency Use Authorization for the treatment of certain hospitalized patients with COVID-19. This section has been updated to include new recommendations regarding the use of convalescent plasma in hospitalized patients with COVID-19 (including those who have impaired humoral immunity) and in nonhospitalized patients with COVID-19. A new clinical data table summarizes the results from several randomized clinical trials and retrospective cohort studies of convalescent plasma use in patients with COVID-19.
Interleukin-6 Inhibitors (With Focus on Tocilizumab)
This section has been updated to incorporate and expand on the Panel’s statements on the use of tocilizumab for the treatment of COVID-19 that were released on February 3 and March 5, 2021. This section includes considerations for using tocilizumab in combination with dexamethasone in certain hospitalized patients who are exhibiting rapid respiratory decompensation due to COVID-19. A new clinical data table summarizes the results from key studies of tocilizumab and sarilumab use in patients with COVID-19 that have had the greatest impact on the Panel’s recommendations.
Special Considerations in Children
This section now includes expanded discussions on treatment considerations for children with acute COVID-19. Additions to the section include updated information on the epidemiology and risk factors for COVID-19 in children, vertical transmission of SARS-CoV-2 infection, and multisystem inflammatory syndrome in children (MIS-C).
Other Updates to the Guidelines
The following sections have been updated to include recommendations and special considerations for SARS-CoV-2 vaccination in specific populations:
- Special Considerations in Adults and Children With Cancer
- Special Considerations in Persons with HIV
- Special Considerations in Solid Organ Transplant, Hematopoietic Stem Cell Transplant, and Cellular Therapy Candidates, Donors, and Recipients
The information in the following sections has also been updated:
- Testing for SARS-CoV-2 Infection
- Prevention and Prophylaxis of SARS-CoV-2 Infection
- Oxygenation and Ventilation
- Vitamin C
- Vitamin D
- Considerations for Certain Concomitant Medications in Patients With COVID-19