The latest COVID Therapeutics Guidelines from @COVIDSciOntario are now available here (covid19-sciencetable.ca/sciencebrief/c…)
Lots of new stuff, so let's take a drive ...
Lots of new stuff, so let's take a drive ...
1. The dominance of Omicron in cases means that the monoclonal antibody cocktail of casirivimab + imdevimab is no longer useful. It is sotrovimab or bust!
2. Because we don't have tons of sotrovimab, we are recommending it for the groups most likely to gain overall benefit.
2. Because we don't have tons of sotrovimab, we are recommending it for the groups most likely to gain overall benefit.
These are symptomatic mildly ill patients who are:
70+ years with 1 additional risk factor
50+ AND Indigenous + 1 additional risk factor
Residents of LTC or other congregate care
Hospital-acquired
* other high-risk patients can also be considered (e.g. +++ immunocompromise)
70+ years with 1 additional risk factor
50+ AND Indigenous + 1 additional risk factor
Residents of LTC or other congregate care
Hospital-acquired
* other high-risk patients can also be considered (e.g. +++ immunocompromise)
3. We also are suggesting that—in addition to considering inhaled budesonide (800mcg bid x 14d) for high-risk pts. with mild illness—that fluvoxamine 50mcg --> 100mg tid for 15d be considered.
We aren't certain these work—and fluvox needs pharmacist consultation and F/U but ...
We aren't certain these work—and fluvox needs pharmacist consultation and F/U but ...
4. we think that the potential benefits outweigh the harms, and they are both RELATIVELY cheap and available at present.
5. Because we are concerned about supply of tocilizumab and sarilumab, we have also added the option of baricitinib 4mg daily for moderately and critically ill
5. Because we are concerned about supply of tocilizumab and sarilumab, we have also added the option of baricitinib 4mg daily for moderately and critically ill
Along with our health system partners, we will be monitoring supply and demand carefully in the coming weeks to adjust our recommendations.
In the interest of timeliness, some supporting literature will be coming out AFTER appearing as a summary here. Sorry!
In the interest of timeliness, some supporting literature will be coming out AFTER appearing as a summary here. Sorry!
As always, this is the collective work of many volunteers on the @COVIDSciOntario Drugs & Biologics Clinical Practice Guidelines Working Group, along with many partners who have provided important and meaningful feedback.
Summary design, as always, by the brilliant @tiffany_kan.
Summary design, as always, by the brilliant @tiffany_kan.
Complaints, gripes, disagreements?—happy to hear, learn, and discuss.
Compliments, gift cards, Raptors/Leafs/Drake tix (after team is at full strength and safe to do so)?—send them to amazing Co-Chair @MPaiMD (and ask her to share with me).
Compliments, gift cards, Raptors/Leafs/Drake tix (after team is at full strength and safe to do so)?—send them to amazing Co-Chair @MPaiMD (and ask her to share with me).
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