Japanese rapid/living recommendations on drug management for COVID-19: updated guidelines (September 2021)

Kazuma Yamakawa; Ryo Yamamoto; Takero Terayama; Hideki Hashimoto; Tadashi Ishihara; Go Ishimaru; Haruki Imura; Hiromu Okano; Chihiro Narita; Takuya Mayumi; Hideto Yasuda; Kohei Yamada; Hiroyuki Yamada; Tatsuya Kawasaki; Nobuaki Shime; Kent Doi; Moritoki Egi; Hiroshi Ogura; Morio Aihara; Shigeki Kushimoto; Osamu Nishida; Special Committee of the Japanese Clinical Practice Guidelines for the Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020), the COVID‐19 Task Force

doi:10.1002/ams2.706

Japanese rapid/living recommendations on drug management for COVID-19: updated guidelines (September 2021)

Acute Med Surg. 2021 Nov 16;8(1):e706. doi: 10.1002/ams2.706. eCollection 2021 Jan-Dec.

Authors

Kazuma Yamakawa¹, Ryo Yamamoto², Takero Terayama³, Hideki Hashimoto⁴, Tadashi Ishihara⁵, Go Ishimaru⁶, Haruki Imura⁷, Hiromu Okano⁸, Chihiro Narita⁹, Takuya Mayumi¹⁰, Hideto Yasuda¹¹, Kohei Yamada¹², Hiroyuki Yamada¹³, Tatsuya Kawasaki¹⁴, Nobuaki Shime¹⁵, Kent Doi¹⁶, Moritoki Egi¹⁷, Hiroshi Ogura¹⁸, Morio Aihara¹⁹, Shigeki Kushimoto²⁰, Osamu Nishida²¹; Special Committee of the Japanese Clinical Practice Guidelines for the Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020), the COVID‐19 Task Force

Affiliations

¹ Department of Emergency 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/Department of Health Informatics School of Public Health Kyoto University Kyoto Japan.
⁸ Department of Critical Care and Emergency Medicine National Hospital Organization Yokohama Medical Center Yokohama Japan.
⁹ Department of Emergency Medicine and Intensive Care Medicine Shizuoka General Hospital Shizuoka Japan.
¹⁰ Department of Internal Medicine Kanazawa Municipal Hospital Kanazawa Japan.
¹¹ Department of Emergency and Critical Care Medicine Jichi Medical University Saitama Medical Center Saitama Japan.
¹² Department of Traumatology and Critical Care Medicine National Defense Medical College Tokorozawa Japan.
¹³ Department of Primary Care and Emergency Medicine Kyoto University Hospital Kyoto Japan.
¹⁴ Department of Pediatric Critical Care Shizuoka Children's Hospital Shizuoka Japan.
¹⁵ Department of Emergency and Critical Care Medicine Graduate School of Biomedical and Health Sciences Hiroshima University Hiroshima Japan.
¹⁶ Department of Emergency and Critical Care Medicine The University of Tokyo Tokyo Japan.
¹⁷ Division of Anesthesiology Department of Surgery Related Kobe University Graduate School of Medicine Kobe Japan.
¹⁸ Department of Traumatology and Acute Critical Medicine Osaka University Medical School Suita Japan.
¹⁹ Department of Gastroenterology and Hematology Hirosaki University Graduate School of Medicine Hirosaki Japan.
²⁰ Division of Emergency and Critical Care Medicine Tohoku University Graduate School of Medicine Sendai Japan.
²¹ Department of Anesthesiology and Critical Care Medicine Fujita Health University School of Medicine Toyoake Japan.

Abstract

Background: The coronavirus disease 2019 (COVID-19) 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 the recommendations. The first edition of this guideline was released on September 9, 2020, and this document is the revised edition (version 4.0; released on September 9, 2021). Clinical questions (CQs) were set for the following seven drugs: favipiravir (CQ1), remdesivir (CQ2), corticosteroids (CQ4), tocilizumab (CQ5), anticoagulants (CQ7), baricitinib (CQ8), and casirivimab/imdevimab (CQ9). Two CQs (hydroxychloroquine [CQ3] and ciclesonide [CQ6]) were retrieved in this updated version.

Recommendations: Favipiravir is not suggested for all patients with COVID-19 (GRADE 2C). Remdesivir is suggested for patients with moderate COVID-19 requiring supplemental oxygen/hospitalization (GRADE 2B). Corticosteroids are recommended for patients with moderate COVID-19 requiring supplemental oxygen/hospitalization (GRADE 1B) and for patients with severe COVID-19 requiring mechanical ventilation/intensive care (GRADE 1A); however, their administration is not recommended for patients with mild COVID-19 not requiring supplemental oxygen (GRADE 1B). Tocilizumab is suggested for patients with moderate COVID-19 requiring supplemental oxygen/hospitalization (GRADE 2B). Anticoagulant administration is recommended for patients with moderate COVID-19 requiring supplemental oxygen/hospitalization and patients with severe COVID-19 requiring mechanical ventilation/intensive care (good practice statement). Baricitinib is suggested for patients with moderate COVID-19 requiring supplemental oxygen/hospitalization (GRADE 2C). Casirivimab/imdevimab is recommended for patients with mild COVID-19 not requiring supplemental oxygen (GRADE 1B). We hope that these updated clinical practice guidelines will help medical professionals involved in the care of patients with COVID-19.

Keywords: Coronavirus; GRADE approach; SARS‐CoV‐2; evidence‐based medicine; practice guideline.