To the editor
Due to new data from the literature and accumulated experience, it became necessary to implement some changes in recommendations for management of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection published by Polish Association of Epidemiologists and Infectiologists on March 31, 2020.1 Changes include both primary and supportive therapy in particular stages of the disease (Table 1). They are first of all a consequence of remdesivir registration by the United States Food and Drug Administration and European Medicines Agency that resulted in the recommendation to use this medication at an earlier stage of the disease.2-4 In the recommendations of March 31, 2020 we included chloroquine and hydrochloroquine in the primary therapy, which was a result of no alternative registered therapeutic options and expected new data supporting effectiveness of these drugs. Due to lack of such data, these medications are listed in this annex as a supportive therapy, which is in accordance with the current summary of product characteristics for chloroquine in Poland.5 Additionaly, this annex includes convalescent plasma and low-molecular-weight heparin as a possible supportive therapy.6,7 There is still no sufficient data supporting use of azithromycin, favipiravir, ruxolitinib, oseltamivir, opaganib, and verdinexor in the treatment of patients with SARS-CoV-2 infections, so we do not recommend the use of these medications.
Stage of the disease | Primary therapy | Supportive therapy |
---|---|---|
Asymptomatic or mild | No need | Symptomatic |
Stable |
|
|
Unstable |
plus
|
|
Critical condition (ARDS) |
plus
|
Glucocorticosteroids: methylprednisolone administered intravenously in a dose of 1 mg/kg of body weight per day for 5 days, later 40 mg per day for 3 days, next 10 mg per day for 2 days, or dexamethasone administered intravenously in a dose of 20 mg per day for 5 days, later 10 g per day for 3 days, next 5 mg per day for 2 days. |
a Low-molecular-weight heparin in prophylactic or therapeutic doses according to the general rules for the management of thromboembolic complications Abbreviations: ARDS, acute respiratory distress syndrome; IL-6, interleukin 6 |
Prof. Robert Flisiak, MD, PhD, Department of Infectious Diseases, Medical University of Białystok, ul. Żurawia 14, 15-540 Białystok, Poland, phone: +48 85 741 69 21, email: robert.flisiak1@gmail.com
June 26, 2020.
Robert Flisiak, Andrzej Horban, Jerzy Jaroszewicz, Dorota Kozielewicz, Małgorzata Pawłowska, Miłosz Parczewski, Anna Piekarska, Krzysztof Simon, Krzysztof Tomasiewicz, Dorota Zarębska-Michaluk (RF: Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Białystok, Poland; AH: Department of Infectious Diseases for Adults, Medical University of Warsaw, Warsaw, Poland; JJ: Department of Infectious Diseases and Hepatology, Medical University of Silesia, Katowice, Poland; DK and MPaw: Department of Infectious Diseases and Hepatology, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Bydgoszcz, Poland; MPar: Department of Infectious, Tropical Diseases and Acquired Immunodeficiency, Pomeranian Medical University, Szczecin, Poland; AP: Department of Infectious Diseases and Hepatology, Medical University of Lodz, Łódź, Poland; KS: Department of Infectious Diseases and Hepatology, Medical University of Wrocław, Wrocław, Poland; KT: Department of Infectious Diseases and Hepatology, Medical University of Lublin, Lublin, Poland; DZ-M: Department of Infectious Diseases, Jan Kochanowski University, Kielce, Poland)
None declared.
Flisiak R, Horban A, Jaroszewicz J, et al. Management of SARS-CoV-2 infection: recommendations of the Polish Association of Epidemiologists and Infectiologists. Annex no. 1 as of June 8, 2020. Pol Arch Intern Med. 2020; 130: 557-558. doi:10.20452/pamw.15424
- 1.
- Flisiak R, Horban A, Jaroszewicz J, et al. Management of SARS-CoV-2 infection: recommendations of the Polish Association of Epidemiologists and Infectiologists as of March 31, 2020. Pol Arch Intern Med. 2020; 130: 352-357.Crossref
- 2.
- Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the treatment of COVID-19 - preliminary report. N Engl J Med. 2020 May 22. [Epub ahead of print].
- 3.
- Food and Drug Administration issuance of emergency use authorization for potential COVID-19 treatment. https://www.fda.gov/media/137564/download. Published May 1, 2020. Accessed June 8, 2020.
- 4.
- European Medicines Agency. Summary on compassionate use for Remdesivir Gilead (updated). https://www.ema.europa.eu/en/documents/other/summary-compassionate-use-remdesivir-gilead_en.pdf. Accessed June 8, 2020.
- 5.
- Arechin – Summary of product characteristics. http://www.urpl.gov.pl/sites/default/files/Arechin%20Charakterystyka%20Produktu%20Leczniczego.pdf. Accessed June 8, 2020.
- 6.
- Tang N, Bai H, Chen X, et al. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020; 18: 1094‐1099.Crossref
- 7.
- Ye M, Fu D, Ren Y, et al. Treatment with convalescent plasma for COVID-19 patients in Wuhan, China. J Med Virol. 2020 Apr 15. [Epub ahead of print].Crossref