Entities launch guide for treatment of Covid-19

The SBI (Brazilian Society of Infectious Diseases) presented, on the night of this Friday (3), the main results of a guide that regulates the pharmacological treatment of Covid-19 in adults.

Led by SBI and API (Pan-American Association of Infectious Diseases), the work brings together the efforts of 18 Brazilian and Latin American specialists, including infectologists and methodologists.

The document aims to guide doctors in the care of cases of Covid-19 in the different stages of the disease – mild / moderate, severe or critical.

The methodology used is the same as the guideline of the European Society of Infectious Diseases and the American Society of Infectious Diseases.

“Our goal is to provide consistent information, with evidence-based medicine, so that doctors can apply, with propriety, in all stages of conduct for Covid-19”, says infectologist Alexandre Naime Barbosa, vice president of SBI .

The document addresses all pharmacological interventions, efficacy, safety, adverse events and the benefits that current treatments can offer to patients,

According to Barbosa, the preparation of the guide went through a rigorous evaluation process, which lasted almost a year, in addition to a systematic review with meta-analysis —a statistical approach that associates and compares results from important studies.

“We take all the randomized clinical trials, which are the phase three placebo-controlled, double-blind studies, and we put together the ones that were well done. By putting them together, you get more evidence to know whether the drug works or not. We started from more than a thousand articles on eight different interventions. Sometimes, the same drug can be used in the initial days of treatment or in a patient who already has severe Covid. This is the case with remsevir”, explains Barbosa.

“The large studies included in the publication are multicentric. Each of them took place in several countries. And we are represented”, says infectologist Monica Maria Gomes da Silva.

“We closely monitor the level of evidence of drugs in each of the phases of Covid-19 and propose the recommendation of the appropriate drug in the most different clinical situations. we are in the pandemic”, completes Barbosa.

Injectable dexatamesone, approved by Anvisa at the end of 2022 for treatment against Covid-19, does not appear in the guide. “Although it was a controlled study, it was not a placebo, but that doesn’t mean it shouldn’t be recommended”, explains Barbosa.

The evaluated medications were approved by Anvisa (National Health Surveillance Agency). Nirmatrelvir/ritonavir and baracitinib are incorporated into the SUS (Unified Health System).

“The document brings drugs that we have evidence of in vivo, in people. We have evidence that it works. But in whom? At what time of the disease? This is also important. As much as I make a drug available for broad treatment in the country , I need to be responsible for knowing when to use it, when the investment is justified. The guideline is important because it will say what works, how and when to use it”, explains Silva.

In the coming weeks, the complete guide will be published in the scientific journal Annals of Clinical Microbiology and Antimicrobials, one of the references for infectology. The intention is to update it periodically, according to the need. SBI and the API expect it to be routinely used in all services that care for patients with Covid-19.

Covid-19 in numbers

According to a survey carried out by infectologist Clóvis Arns da Cunha, professor of medicine at the Federal University of Paraná, the Brazilian population estimated for 2022 (the new population census is in progress) —212.7 million— represents approximately 2.7 % of global 7.7 billion.

The number of Brazilians who have died from Covid-19 (697,074) since the beginning of the pandemic represents 10.3% of the total number of deaths (6,763,000) from the disease in the world – data updated on February 1st.

“In absolute numbers, Brazil is the second country with the most deaths. In the next few days, it will reach 700,000 lives taken. to the population, Peru is number one among the countries that had the most deaths in its population. Latin America, as a whole, was overwhelmed by Covid”, says Cunha.