What are the treatment regimens commonly used for the different levels of severity of COVID-19 in the Philippines?

SPMC Journal of Health Care Services

CURATED INFORMATION

What are the treatment regimens commonly used for the different levels of severity of COVID-19 in the Philippines?

SPMC J Health Care Serv. 2022;8(1):2 ARK: https://n2t.net/ark:/76951/jhcs47c3cs

Collated by

Christine May Perandos-Astudillo¹

¹Research Utilization and Publication Office, Southern Philippines Medical Center, JP Laurel Ave, Davao City, Philippines

Correspondence Christine May Perandos-Astudillo, alleiandrah@gmail.com

Received 30 March 2022

Accepted 8 April 2022

Cite as Perandos-Astudillo CM. What are the treatment regimens commonly used for the different levels of severity of COVID-19 in the Philippines? SPMC J Health Care Serv. 2022;8(1):2. https://n2t.net/ark:/76951/jhcs47c3cs

The Philippine COVID-19 Living Clinical Practice Guidelines (CPG) is a set of guidelines that provides up-to-date evidence-based recommendations on COVID-19 treatment, diagnosis, infection prevention and control. This living guideline follows the Department of Health’s Manual for Clinical Practice Guideline Development¹ and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Approach.²

The diagram below is a summary of the treatment regimens gathered from the Philippine COVID-19 Living Recommendations website. The recommendation for each drug regimen is based on the assessment and literature review done by the Living CPG Task Force (LCTF).³ The LCTF follows the classification of quality of evidence enumerated and described in Box 1.

Box 1 GRADE quality of evidence as assessed by the Living CPG Task Force (LCTF)³
High - We are very confident that the true effect lies close to that of the estimate of the effect. Moderate - We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low - Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low - We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

Box 1 GRADE quality of evidence as assessed by the Living CPG Task Force (LCTF)³

High - We are very confident that the true effect lies close to that of the estimate of the effect.
Moderate - We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low - Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect.
Very low - We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

LCTF recommendations


		Tocilizumab + systemic steroids Specifically for: patients showing rapid respiratory deterioration and/or requiring high doses of oxygen (high-flow nasal cannula, noninvasive or invasive mechanical ventilation) and with elevated biomarkers of inflammation (CRP). Quality of evidence: moderate LCTF recommendation: strong for use Source: https://www.psmid.org/tocilizumab-evidence-summary/ Information up to date as of: October 28, 2021
Bamlanivimab + etesevimab Specifically for: non-hospitalized patients with at least one of the following risk factors for progression to severe disease: age≥65 years, body mass index ≥35 kg/m², cardiovascular disease (including hypertension), chronic lung disease (including asthma), chronic metabolic disease (including diabetes), chronic kidney disease (including receipt of dialysis), chronic liver disease, and immunocompromised conditions Quality of evidence: low LCTF recommendation: weak for use Source: https://www.psmid.org/bamlanivimab-and-etesevimab-evidence-summary/ Information up to date as of: October 12, 2021		Remdesivir + dexamethasone Specifically for: patients who have oxygen saturation of <94% and/ or who require oxygen supplementation Quality of evidence: low LCTF recommendation: conditional for use Source: https://www.psmid.org/remdesivir-evidence-summary/ Information up to date as of: March 26, 2021
Casirivimab-imdevimab Specifically for: symptomatic, non-hospitalized patients with at least one of the following risk factors for severe COVID-19: age>50 years, obesity, cardiovascular disease (including hypertension), chronic lung disease (including asthma), chronic metabolic disease (including diabetes), chronic kidney disease (including receipt of dialysis), chronic liver disease, and immunocompromised conditions Quality of evidence: moderate LCTF recommendation: weak for use Source: https://www.psmid.org/casirivimab-imdevimab-treatment-evidence-summary/ Information up to date as of: December 20, 2021
Molnupiravir Specifically for: within 5 days of symptom onset among non-hospitalized adult patients (18 years old and above) with mild to moderate COVID-19 infection, and with at least one of the following risk factors for progression: age>60 years, active cancer, chronic kidney disease, chronic obstructive pulmonary disease, obesity, serious heart conditions or diabetes mellitus Quality of evidence: low LCTF recommendation: weak for use Source: https://www.psmid.org/molnupiravir-evidence-summary/ Information up to date as of: January 10, 2022
	Baricitinib + dexamethasone + remdesivir Specifically for: patients who require low-flow oxygen, high-flow oxygen, or non-invasive ventilation Quality of evidence: low LCTF recommendation: weak for use Source: https://www.psmid.org/baricitinib-evidence-summary/ Information up to date as of: October 21, 2021
Tocilizumab Specifically for: patients who do not require oxygen Quality of evidence: very low LCTF recommendation: strong against use Source: https://www.psmid.org/tocilizumab-evidence-summary/ Information up to date as of: October 28, 2021		Casirivimab-imdevimab Specifically for: hospitalized patients Quality of evidence: moderate LCTF recommendation: strong against use Source: https://www.psmid.org/convalescent-plasma-evidence-summary/ Information up to date as of: January 10, 2022
Systemic corticosteroids Specifically for: mild and moderate (non-oxygen requiring) COVID-19 patients Quality of evidence: moderate LCTF recommendation: strong against use Source: https://www.psmid.org/corticosteroids-evidence-summary/ Information up to date as of: January 3, 2022
Hydroxychloroquine / Chloroquine with or without azithromycin Specifically for: patients with COVID-19 of any severity Quality of evidence: moderate LCTF recommendation: strong against use Source: https://www.psmid.org/hydroxychloroquine-chloroquine-evidence-summary/ Information up to date as of: February 19, 2021
Convalescent plasma Specifically for: patients with COVID-19 infection of any severity Quality of evidence: moderate LCTF recommendation: strong against use Source: https://www.psmid.org/casirivimab-imdevimab-treatment-evidence-summary/ Information up to date as of: November 18, 2021
Azithromycin Specifically for: patients with COVID-19 regardless of disease severity Quality of evidence: moderate LCTF recommendation: strong against use Source: https://www.psmid.org/azithromycin-evidence-summary-2/ Information up to date as of: December 1, 2021
Ivermectin alone Specifically for: patients with COVID-19 of any severity Quality of evidence: very low LCTF recommendation: strong against use Source: https://www.psmid.org/ivermectin-evidence-summary/ Information up to date as of: December 6, 2021
Remdesivir Specifically for: patients who have O2 saturation of ≥94% and do not require oxygen supplementation Quality of evidence: low LCTF recommendation: conditional against use Source: https://www.psmid.org/remdesivir-evidence-summary/ Information up to date as of: March 26, 2021
	Intravenous immunoglobulin Specifically for: patients with moderate to severe COVID-19 Quality of evidence: very low LCTF recommendation: conditional against use Source: https://www.psmid.org/intravenous-immunoglobulin-evidence-summary/ Information up to date as of: May 18, 2021
Ivermectin + doxycycline Specifically for: patients with COVID-19 of any severity Quality of evidence: very low LCTF recommendation: conditional against use Source: https://www.psmid.org/ivermectin-evidence-summary/ Information up to date as of: December 6, 2021
Favipiravir Specifically for: patients with mild to severe COVID-19 Quality of evidence: low LCTF recommendation: none Source: https://www.psmid.org/favipiravir-evidence-summary/ Information up to date as of: November 8, 2021			Remdesivir Specifically for: patients who are already on high flow oxygen, non-invasive or invasive mechanical ventilation or ECMO Quality of evidence: low Source: https://www.psmid.org/remdesivir-evidence-summary/ Information up to date as of: March 26, 2021
Lianhua Qingwen Specifically for: patients with non-severe COVID-19 Quality of evidence: very low LCTF recommendation: none Source: https://www.psmid.org/philippine-covid-19-living-recommendations/ Information up to date as of: December 6, 2021		Baricitinib as an alternative to tocilizumab Specifically for: hospitalized patients Quality of evidence: very low LCTF recommendation: none Source: https://www.psmid.org/baricitinib-evidence-summary/ Information up to date as of: October 21, 2021
Virgin Coconut Oil Specifically for: patients with COVID-19 regardless of disease severity Quality of evidence: none LCTF recommendation: none Source: https://www.psmid.org/virgin-coconut-oil-evidence-summary/ Information up to date as of: March 26, 2021

References

1. Department of Health - Philippines, Philippine Health Insurance Corporation. Manual for clinical practice guideline development. Manila: Department or Health. 2018. Available from: https://www.psmid.org/wp-content/uploads/2021/09/CPG-Manual-First-Edition_2018_27_11.pdf.

2. Schünemann H, Brożek J, Guyatt G, Oxman A. GRADE Handbook. 2013. Available from: https://gdt.gradepro.org/app/handbook/handbook.html#ftnt_ref1.

3. Insitute of Clinical Epidemiology, National Institutes of Health, University of the Philippines - Manila. Philippine COVID-19 living recommendations. Manila: University of the Philippines. 9 May 2021. Available from: https://www.psmid.org/wp-content/uploads/2021/05/Living-Recommendations_28-May-2021.pdf.

Published

April 8, 2022

Issue

Volume 8 Issue 1 (2022)

Section

Curated Information

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SPMC Journal of Health Care Services