A living WHO guideline on drugs to prevent covid-19.

What is the role of drugs in preventing covid-19? WHY DOES THIS MATTER?: There is widespread interest in whether drug interventions can be used for the prevention of covid-19, but there is uncertainty about which drugs, if any, are effective. The first version of this living guideline focuses on the evidence for hydroxychloroquine. Subsequent updates will cover other drugs being investigated for their role in the prevention of covid-19. The guideline development panel made a strong recommendation against the use of hydroxychloroquine for individuals who do not have covid-19 (high certainty). This living guideline is from the World Health Organization (WHO) and provides up to date covid-19 guidance to inform policy and practice worldwide. Magic Evidence Ecosystem Foundation (MAGIC) provided methodological support. A living systematic review with network analysis informed the recommendations. An international guideline development panel of content experts, clinicians, patients, an ethicist and methodologists produced recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The linked systematic review and network meta-analysis (6 trials and 6059 participants) found that hydroxychloroquine had a small or no effect on mortality and admission to hospital (high certainty evidence). There was a small or no effect on laboratory confirmed SARS-CoV-2 infection (moderate certainty evidence) but probably increased adverse events leading to discontinuation (moderate certainty evidence). The panel judged that almost all people would not consider this drug worthwhile. In addition, the panel decided that contextual factors such as resources, feasibility, acceptability, and equity for countries and healthcare systems were unlikely to alter the recommendation. The panel considers that this drug is no longer a research priority and that resources should rather be oriented to evaluate other more promising drugs to prevent covid-19. This is a living guideline. New recommendations will be published in this article and signposted by update notices to this guideline. This is the first version of the living guideline for drugs to prevent covid-19. It complements the WHO living guideline on drugs to treat covid-19. When citing this article, please consider adding the update number and date of access for clarity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Citation

François Lamontagne, Miriam Stegemann, Arnav Agarwal, Thomas Agoritsas, Reed Siemieniuk, Bram Rochwerg, Jessica Bartoszko, Lisa Askie, Helen Macdonald, Muna Al-Maslamani, Wagdy Amin, Andre Ricardo Araujo Da Silva, Fabian Alberto Jaimes Barragan, Frederique Jacquerioz Bausch, Erlina Burhan, Maurizio Cecconi, Binila Chacko, Duncan Chanda, Vu Quoc Dat, Bin Du, Heike Geduld, Patrick Gee, Muhammad Haider, Harley Nerina, Madiha Hashimi, Fyezah Jehan, David Hui, Beverley J Hunt, Mohamed Ismail, Sushil Kabra, Seema Kanda, Leticia Kawano-Dourado, Yae-Jean Kim, Niranjan Kissoon, Sanjeev Krishna, Arthur Kwizera, Thiago Lisboa, Yee-Sin Leo, Imelda Mahaka, Manai Hela, Giovanni Battista Migliori, Greta Mino, Emmanuel Nsutebu, Natalia Pshenichnaya, Nida Qadir, Shalini Sri Ranganathan, Saniya Sabzwari, Rohit Sarin, Manu Shankar-Hari, Michael Sharland, Yinzhong Shen, Joao Paulo Souza, Tshokey Tshokey, Sebastian Ugarte, Tim Uyeki, Sridhar Venkatapuram, Ablo Prudence Wachinou, Ananda Wijewickrama, Dubula Vuyiseka, Jacobus Preller, Romina Brignardello-Petersen, Elena Kum, Anila Qasim, Dena Zeraatkar, Andrew Owen, Gordon Guyatt, Lyubov Lytvyn, Michael Jacobs, Per Olav Vandvik, Janet Diaz. A living WHO guideline on drugs to prevent covid-19. BMJ (Clinical research ed.). 2021 Mar 01;372:n526

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PMID: 33649077

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