Neurological

Can the practice guidelines for inpatient drug therapies for COVID-19 be trusted?

During the COVID-19 pandemic, clinicians need fast and urgent guidance to treat affected patients and prevent transmission. However, according to a recent systematic review published in the JAMA Network Open, few clinical practice guidelines (CPGs) developed for pharmacological treatments in hospitalized patients with COVID-19 meet the National Academy of Medicine’s standards for trustworthy guidelines.

Researchers in Canada searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials and searched all titles and abstracts of citations for guidelines eligible for review. All 32 guidelines included in the review covered pharmacological treatment for COVID-19 and were led by researchers and sponsored or created by a national or international scientific organization or a government or non-governmental organization related to global health.

Investigators found that most of the CPGs were of low quality. Few CPGs (1) disclosed funding sources or conflicts of interest; (2) included a methodologist; (3) described a search strategy or study selection process; or {4) synthesized evidence. Although 14 guidelines (43.8%) made recommendations or suggestions for or against treatments, only 6 (18.8%) rated confidence in the quality of the evidence; 6 (18.8%) described potential benefits and harms; and 5 (15.6%) enrolled a methodologist and rated the strength of the recommendations. Only 7 CPGs (21.9%) reported funding sources and 12 (37.5%) disclosed conflicts of interest.

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According to investigators, the chaos and urgency surrounding COVID-19 certainly contributed to the deficiencies found in the guidelines, but strict methodological standards for guidelines are critical to avoid promoting useless or potentially harmful treatments and wasting valuable healthcare resources. Certain strategies could encourage the development of trustworthy guidelines even in a pandemic, they claimed, and suggested that: (1) guideline panels should include a methodologist such as an epidemiologist, biostatistician, or health researcher; (2) Collaborations of multidisciplinary participants from at least 2 regions of the World Health Organization could pool their expertise to create fewer but better quality guidelines; and (3) journal editors and peer reviewers could require the use of CPG scoring tools at the time of submission to ensure publication of quality guidelines.

The authors acknowledge certain limitations of their review, including: they limited their search to guiding principles published in peer-reviewed journals; they have not verified the methodology of the guideline; and they did not determine whether guidelines were assessed for quality at the time of submission. Nevertheless, the findings are important. “These points underscore the need for high publishing standards even in the unique circumstances of a pandemic,” the researchers warned.

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Burns KEA, Laird M, Stevenson J, et al. Adherence to clinical practice guidelines for the pharmacological management of hospitalized patients with COVID-19 according to trusted standards: a systematic review. JAMA network open. Published online December 1, 2021. doi:10.1001/jamanetworkopen.2021.36263

This article originally appeared on Pulmonology Advisor

Subjects:

COVID19 general medicine

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