key: cord-0985680-wn1avkdc
authors: Amariles, Pedro; Hincapie-García, Jaime; Julio Montoya, Carlos
title: Pharmacotherapy for hospitalized patients with COVID-19: Waiting or doing?
date: 2020-05-13
journal: Res Social Adm Pharm
DOI: 10.1016/j.sapharm.2020.05.010
sha: d4efe757768f37bd1c22dd5f9f522bdea965dcf7
doc_id: 985680
cord_uid: wn1avkdc

nan

According to reports of clinical studies, several drug therapies could be potentially helpful as treatment options for patients with COVID-19, 1 and they are being evaluated. For instance, chloroquine/hydroxychloroquine (CQ)/(HCQ), 2 tocilizumab, 3 lopinavir/ritonavir, 4 or remdesivir. 5 The message regarding the pharmacotherapy of hospitalized patients with COVID-19 is clear; unfortunately, it could be regarded as unenthusiastic because there is no accurate and sufficient evidence to recommend any specific treatment for patients. Similarly, a recent rapid systematic review of clinical trials utilizing chloroquine and hydroxychloroquine as a treatment for COVID-19 concluded that: "there is currently not enough data available to support the routine use of HCQ andCQ as therapies for COVID-19". 6 The situation underscores the need to design and develop more randomized and controlled clinical trials with these drugs in patients with COVID-19. In addition, it is necessary to offer some available pharmacotherapy options both with a plausible mechanism of action and with information that show some favorable risk/benefit relation in patients hospitalized with moderate or severe COVID-19. This practice would be adjusted to guidelines on the treatment and management of patients with COVID-19, as follows: "in the context of a clinical trial" (drug-therapy with knowledge gap) or "only in the context of a clinical trial" (drug therapy with higher uncertainty or more potential for harm). 1 Results and conclusions of these clinical trials could be controversial; that is, some primary outcomes will prove positive and convince, while others will prove negative or will be inconclusive, and yield additional safety concerns. 7 We have been waiting for several months, and maybe we must wait one or more years for guidelines supported on highquality evidence for the specific therapy of moderate and severe COVID-19. While we should stay up to date with results of clinical trials regarding pharmacotherapy of patients with COVID-19, we must also must also perform our reading diligently, thus cautiously interpreting the methods, results, and conclusions. We must make a critical appraisal of the clinical and sociodemographic conditions of the patients included in the studies. Even more, we must recognize the core outcome set of these studies and discuss the implications of results in terms of invasive mechanical ventilation or hard outcomes as death. 6 It implies a call to action, and not only for waiting.

Clinicians and scientists must contribute by performing clinical trials, promoting collaborative learning, considering the context in every country -independent of its degree of development-, even pushing the limits of global governance. It will help us to generate evidence for drug options in this critical outbreak and promote its incorporation into clinical practice. In conclusion, we have an obligation to do and not wait; we have to act in concordance to this historical moment. 

Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19

Hydroxychloroquine in patients with COVID-19: an open-label, randomized

Pilot prospective open, single-arm multicentre study on off-label use of tocilizumab in severe patients with COVID-19

A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19

Compassionate Use of Remdesivir for Patients with Severe Covid-19

A Rapid Systematic Review of Clinical Trials Utilizing Chloroquine and Hydroxychloroquine as a Treatment for COVID-19

An evaluation of co-use of chloroquine