Abstract
Due to condensed development processes, expanding evidence and differences in healthcare system characteristics, many COVID-19 guidelines differ in their quality and treatment recommendations, which has consequences for clinical practice. This review aimed to identify COVID-19 treatment guidelines, assess their quality, and summarise their recommendations. Guidelines were identified for five therapies most commonly used among inpatients with COVID-19 (remdesivir, dexamethasone, tocilizumab, baricitinib, and casirivimab/imdevimab) from 11 countries. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) tool. Full details of recommendations and supporting evidence were analysed for high-quality guidelines, defined as those scoring ≥50% in Domain 3 (Rigour of Development) of AGREE-II. Overall, guidelines differed substantially in their quality and, even among high-quality guidelines using the same evidence, recommendations regarding specific therapeutics varied. Potential reasons for this heterogeneity, including the availability and consistency of clinical data, visibility of trial endpoints, and context-specific factors, are discussed.
Footnotes
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Authors’ Contributions: Substantial contributions to study conception and design: DAW; AAE; LD; CYW; AL; RAB; AR; JKR; substantial contributions to analysis and interpretation of the data: DAW; AAE; LD; CYW; AL; RAB; AR; KCS; JKR; drafting the article or revising it critically for important intellectual content: DAW; AAE; LD; CYW; AL; RAB; AR; KCS; JKR; final approval of the version of the article to be published: DAW; AAE; LD; CYW; AL; RAB; AR; KCS; JKR.
Conflicts of Interest: Chen-Yu Wang received support for the present manuscript from Gilead Sciences, for which they are an employee; stock or stock options owned for Gilead Sciences.
Conflicts of Interest: David Alain Wohl received support for the present manuscript from Gilead Sciences; the following relationships have been disclosed outside the submitted work; grants or contracts received from Gilead Sciences, Eli Lilly and Merck & Co; honoraria received for educational activities from Gilead Sciences.
Conflicts of Interest: Jürgen Rockstroh reports the following relationships outside the submitted work; consulting fees from Gilead, Janssen, Merck and ViiV; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events for Gilead, Janssen, Merck, Theratechnologies and ViiV; participation on a Data Safety Monitoring Board or Advisory Board for Abivax, Glapagos, Gilead, Merck and ViiV.
Conflicts of Interest: Kerris Chappell-Smith received support for the present manuscript from Costello Medical.
Conflicts of Interest: Rujuta A Bam (Rujuta N Phadke) received support for the present manuscript from Gilead Sciences, for which they are an employee; stock or stock options owned for Gilead Sciences.
Conflicts of Interest: The remaining authors have nothing to disclose.
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- Received May 12, 2022.
- Accepted August 18, 2022.
- Copyright ©The authors 2022
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