Evidence Check - Symptoms, diagnosis and treatment

Asymptomatic, disease progression, ambulance, drugs, community, hospitalisation, recovery, palliative care, death.

Monoclonal antibodies

Added: 13 Dec 2021

What is the evidence for the use of monoclonal antibody treatments for COVID-19?
  • Monoclonal antibodies that target surface viral proteins may be used for the prevention and treatment of COVID-19. In Australia, the Therapeutic Goods Administration (TGA) has provisionally approved certain monoclonal antibody treatments and the Australian National COVID-19 Clinical Evidence Taskforce has published living guidance for use.
  • A Cochrane review concluded there was insufficient evidence regarding the effectiveness of treatment with monoclonal antibodies including reduced mortality, improved symptoms, admissions to hospital, and serious or unwanted effects.
  • Other systematic reviews have reported mixed evidence for reduced mortality, reduced hospitalisations or ICU admissions, progression to ventilation or severe disease, and risk of poor clinical outcomes or adverse events.

Renal dialysis and COVID-19 vaccination

Added: 13 Dec 2021

What is the evidence for the use of SARS-CoV-2 vaccinations in renal dialysis patients?
  • Generally, studies have shown SARS-CoV-2 vaccinations are safe and effective in renal dialysis patients, with a substantial humoral response for most patients after two vaccine doses.
  • However, the humoral response rate may be lower in renal dialysis patients compared to the general population. This may justify changes to the vaccination schedule for these patients.
  • SARS-CoV-2 vaccines are not contraindicated in kidney disease patients and Kidney Health Australia recommends vaccination for people with kidney disease, including patients on dialysis.

Post-acute sequelae of COVID-19

Added: 6 Dec 2021

What is the evidence on the post-acute sequelae of COVID-19?
  • The global estimated pooled PASC prevalence ranges from 43% to 63%, with a higher pooled PASC prevalence estimate among those hospitalised during the acute phase of infection.
  • Risk factors for the development of PASC may include those who had symptomatic COVID-19 infection, hospitalisation, and severity of illness. Other potential risk factors include old age, female sex, a high number of comorbidities and moderate and severe obesity.
  • Whilst some symptoms are specific to different points in time following acute illness (table one), fatigue, dyspnoea and smell or taste impairment are consistently reported for twelve months.

Sotrovimab

Added: 6 Dec 2021

What is the evidence for sotrovimab as a treatment for COVID-19?
  • Sotrovimab (XEVUDY), is a monoclonal antibody treatment for COVID-19.
  • Sotrovimab is provisionally approved and included in the Australian Register of Therapeutic Goods (ARTG).
  • Interim data from a phase 3 trial (COMET-ICE) show the risk of disease progression was reduced by 85%.

Molnupiravir

Added: 14 Oct 2021
Updated: 24 Nov 2021

What is the evidence for and regulatory context of molnupiravir for treatment of COVID-19?
  • Molnupiravir (MK-4482/EIDD-2801), is an antiviral medication that is administered orally.
  • Molnupiravir is a potent ribonucleoside analogue that inhibits the viral replication of SARS-CoV-2 (or other viruses that employ RNA-dependant RNA polymerase) by introducing errors in the viral genome.
  • There are currently four clinical trials underway to explore the use of molnupiravir. These include interim results from a phase 3 trial, a pre-print phase 2 trial and two phase 1 trials with small numbers of participants.
  • In these trials, results are promising with molnupiravir reducing the risk of hospitalisation or death by approximately 50%, with no serious adverse events. In the phase 2a trial, the intervention arm had a significantly lower median time for the virus to clear.

Respiratory therapies and COVID-19

Added: 4 Nov 2021

What is the evidence for the use of respiratory therapies for the management of COVID-19?
  • Respiratory therapies may be used to provide oxygen for adults with COVID-19. Alternatives to invasive mechanical ventilation include standard oxygen delivery devices, non-invasive ventilation, including continuous positive airway pressure (CPAP), and high flow nasal oxygen therapy.
  • Aerosol-generating procedures increase transmission risk and may result in airborne transmission of COVID-19. Many respiratory therapies are considered to be aerosol-generating procedures.
  • Prone positioning is a technique used to help patients with acute respiratory distress syndrome (ARDS) breathe better and may be beneficial in awake patients with COVID-19.

Foetal and neonatal outcomes of COVID-19 in pregnancy

Added: 29 Oct 2021

What evidence is available for adverse foetal and neonatal outcomes, for example miscarriage, stillbirth and neonatal death, associated with COVID-19 infection during pregnancy?
  • Pregnant people with COVID-19 may be at increased risk of adverse birth outcomes, including preterm delivery, low birth weight and neonatal intensive care unit admission. However, there was no increased risk of foetal or neonatal mortality compared to the general population.
  • Severe COVID-19 infections in pregnant people were associated with foetal death, stillbirth, preterm birth, and low birth weight.
  • The risk of neonatal intensive care unit admission is higher in pregnant people with COVID-19 compared to those without COVID-19.

Initiation of remdesivir treatment for COVID-19

Added: 1 Oct 2021

What is the evidence on timing of initiation of remdesivir treatment for COVID-19?
  • Remdesivir is an antiviral drug that has been authorised for emergency use to treat COVID-19 in several countries.
  • In November 2020, the World Health Organization published a conditional recommendation against the use of remdesivir in hospitalised patients with COVID-19 noting insufficient evidence to support its use.
  • Many studies show that in patients with mild-to-moderate COVID-19 cases with no requirement for respiratory support, remdesivir does not offer significant clinical benefits. However, for patients with severe COVID-19, at risk of hyperinflammation and requiring supplemental oxygen, remdesivir shortens time to recovery and reduces risk of progression when diagnosed early (≤10 days).

Daily Evidence Digest

Rapid evidence checks are based on a simplified review method and may not be entirely exhaustive, but aim to provide a balanced assessment of what is already known about a specific problem or issue. This brief has not been peer-reviewed and should not be a substitute for individual clinical judgement, nor is it an endorsed position of NSW Health.

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