A living WHO guideline on drugs to prevent covid-19
François Lamontagne, Miriam Stegemann, Arnav Agarwal, Thomas Agoritsas, Reed Siemieniuk, Bram Rochwerg, Jessica J Bartoszko, Lisa Askie, Helen Macdonald, Muna Almaslamani, Wagdy Amin, André Ricardo Araújo da Silva, Fabián Alberto Jaimes Barragán, Frédérique Jacquerioz Bausch, Erlina Burhan, Maurizio Cecconi, Binila Chacko, Duncan Chanda, Vu Quoc Dat, Bin Du, Heike Geduld, Patrick O. Gee, Muhammad Mohsin Haider, Nerina Harley, Madiha Hashimi, Fyezah Jehan, David S.C. Hui, Beverley J. Hunt, Mohamed Ismail, S. K. Kabra, Seema Kanda, Letícia Kawano-Dourado, Yae‐Jean Kim, Niranjan Kissoon, Sanjeev Krishna, Arthur Kwizera, Thiago Lisboa, Yee‐Sin Leo, Imelda Mahaka, Hela Manai, Giovanni Battista Migliori, G Miño, Emmanuel Nsutebu, N. Pshenichnaya, Nida Qadir, Shalini Sri Ranganathan, Saniya Sabzwari, Rohit Sarin, Manu Shankar‐Hari, Michael Sharland, Yinzhong Shen, João Paulo Souza, Tshokey Tshokey, Sebastián 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 Dı́az
Abstract
CLINICAL QUESTION: 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. RECOMMENDATION: The guideline development panel made a strong recommendation against the use of hydroxychloroquine for individuals who do not have covid-19 (high certainty). HOW THIS GUIDELINE WAS CREATED: 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. UNDERSTANDING THE NEW RECOMMENDATION: 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. UPDATES: This is a living guideline. New recommendations will be published in this article and signposted by update notices to this guideline. READERS NOTE: 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.