ATS Releases Consensus on Hydroxychloroquine Use, Other Treatment Methods
An international task force led by the American Thoracic Society has developed interim consensus guidance for the treatment of patients with coronavirus disease 2019 (COVID‐19). Included are suggestions regarding the use of hydroxychloroquine (HCQ), chloroquine (CQ), prone ventilation, and extracorporeal membrane oxygenation (ECMO).
While empirical evidence to guide treatment is limited and needed, the task force hopes that its consensus suggestions can help standardize care and improve outcomes until more empirical evidence becomes available.
“Pending the results of clinical trials, this document is aimed at providing interim guidance for therapeutic interventions to frontline clinicians, based upon scarce direct evidence, indirect evidence, and the observations and experiences of clinicians around the world who have battled COVID‐19; they are not based upon systematic reviews of the evidence,” the authors wrote.
The task force comprised clinicians from academic centers actively treating patients with COVID‐19. Among their consensus suggestions are the following:
- HCQ (or CQ) should be administered on a case‐by‐case basis to hospitalized patients with COVID‐19 who have evidence of pneumonia if all of the following apply:
- Shared decision‐making is utilized
- Data are collected for research comparing HCQ with no HCQ, or CQ with no CQ
- Illness is severe enough to warrant investigational therapy
- HCQ or CQ are not in short supply
- Prone ventilation should be used for patients with refractory hypoxemia due to progressive COVID‐19 pneumonia.
- If prone ventilation fails, ECMO should be considered for patients with refractory hypoxemia due to progressive COVID‐19 pneumonia.
The task force also suggests that clinicians collect data from patients with COVID-19 who have received any of the suggested interventions. Such data should be compared with data from patients who did not receive the intervention. Based on those comparisons, management should be modified as needed.
The task force made no suggestions for or against treatment with remdesivir, lopinavir‐ritonavir, tocilizumab, or systemic corticosteroids. Suggestions regarding HCQ or CQ use among outpatients with COVID-19 or among hospitalized patients with COVID-19 without pneumonia were not made.
As more evidence becomes available, the task force will revisit its suggestions.
American Thoracic Society‐led international task force. COVID-19 interim guidance on management pending empirical evidence. Updated April 3, 2020. Accessed April 6, 2020. https://www.thoracic.org/professionals/clinical-resources/disease-related-resources/covid-19-guidance.pdf