A living WHO guideline on drugs to prevent covid-19
Authors: François Lamontagne, Miriam Stegemann, Arnav Agarwal, Thomas Agoritsas, Reed Siemieniuk, Bram Rochwerg, Jessica Bartoszko, Lisa Askie, Helen Macdonald, Muna Al-Maslamani, Wagdy Amin, Andre Ricardo Araujo Da Silva, Fabian Alberto Jaimes Barragan, Frederique Jacquerioz Bausch, Erlina Burhan, Maurizio Cecconi, Binila Chacko, Duncan Chanda, Vu Quoc Dat, Bin Du, Heike Geduld, Patrick Gee, Muhammad Haider, Nerina Harley, Madiha Hashimi, Fyezah Jehan, David Hui, Beverley J Hunt, Mohamed Ismail, Sushil Kabra, Seema Kanda, Leticia Kawano-Dourado, Yae-Jean Kim, Niranjan Kissoon, Sanjeev Krishna, Arthur Kwizera, Thiago Lisboa, Yee-Sin Leo, Imelda Mahaka, Manai Hela, Giovanni Battista Migliori, Greta Mino, Emmanuel Nsutebu, Natalia Pshenichnaya, Nida Qadir, Shalini Sri Ranganathan, Saniya Sabzwari, Rohit Sarin, Manu Shankar-Hari, Michael Sharland, Yinzhong Shen, Joao Paulo Souza, Tshokey Tshokey, Sebastian Ugarte, Tim Uyeki, Sridhar Venkatapuram, Ablo Prudence Wachinou, Ananda Wijewickrama, Dubula Vuyiseka, Jacobus Preller, Romina Brignardello-Petersen, Elena Kum, Anila Qasim, Dena Zeraatkar, Andrew Owen, Gordon Guyatt, Lyubov Lytvyn, Michael Jacobs, Per Olav Vandvik, Janet Diaz
Journal: BMJ (2021)

Abstract Clinical question What is the role of drugs in preventing covid-19? Why does this matter? There is widespread interest in whether drug interventions can be used for the prevention of covid-19, but there is uncertainty about which drugs, if any, are effective. Recommendations The second version of this living guideline reiterates the previous strong recommendation against the use of hydroxychloroquine and includes a new conditional recommendation against the use of tixagevimab-cilgavimab in individuals who do not have covid-19. How this guideline was created This living guideline is from the World Health Organization (WHO) and provides up to date covid-19 guidance to inform policy and practice worldwide. Magic Evidence Ecosystem Foundation (MAGIC) provides methodological support. A living systematic review with network analysis informs the recommendations. An international guideline development group (GDG) of content experts, clinicians, patients, an ethicist and methodologists produces recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Understanding the recommendations The living network meta-analysis informing this guideline included 12 trials (8379 participants) comparing hydroxychloroquine to standard care/placebo, and one trial (5197 participants) comparing tixagevimab-cilgavimab to standard care/placebo. When moving from evidence to the continued strong recommendation against the use of hydroxychloroquine, the GDG emphasised additional evidence suggesting no or little effect on mortality and hospital admission, and an increased risk of adverse effects. For the new conditional recommendation against the use of tixagevimab-cilgavimab, the GDG emphasised in vitro evidence reducing the applicability of available trial data. While trial results demonstrated modest reduction in the occurrence of laboratory confirmed symptomatic covid-19, lack of in vitro neutralisation of new SARS-CoV-2 sub-lineages was considered to have rendered these results obsolete. Updates This is a living guideline. New recommendations will be published in this article and signposted by update notices to this guideline. Readers note This is the second version of the living guideline for drugs to prevent covid-19. It complements the WHO living guideline on drugs to treat covid-19 and living guidance regarding covid-19 related clinical management. When citing this article, please consider adding the update number and date of access for clarity.