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Practice Guideline
. 2021 Mar 1:372:n526.
doi: 10.1136/bmj.n526.

A living WHO guideline on drugs to prevent covid-19

François Lamontagne  1   2 , Miriam Stegemann  3   2 , Arnav Agarwal  4   2 , Thomas Agoritsas  5   6   7   2 , Reed Siemieniuk  6   8   2 , Bram Rochwerg  6   8   2 , Jessica Bartoszko  6   2 , Lisa Askie  9   2 , Helen Macdonald  10   2 , Muna Al-Maslamani  11 , Wagdy Amin  12 , Andre Ricardo Araujo Da Silva  13 , Fabian Alberto Jaimes Barragan  14 , Frederique Jacquerioz Bausch  15 , Erlina Burhan  16 , Maurizio Cecconi  17 , Binila Chacko  18 , Duncan Chanda  19 , Vu Quoc Dat  20 , Bin Du  21 , Heike Geduld  22 , Patrick Gee  23 , Muhammad Haider  24 , Harley Nerina  25 , Madiha Hashimi  26 , Fyezah Jehan  27 , David Hui  28 , Beverley J Hunt  29 , Mohamed Ismail  30 , Sushil Kabra  31 , Seema Kanda  32 , Leticia Kawano-Dourado  33 , Yae-Jean Kim  34 , Niranjan Kissoon  35 , Sanjeev Krishna  36 , Arthur Kwizera  37 , Thiago Lisboa  38 , Yee-Sin Leo  39 , Imelda Mahaka  40 , Manai Hela  41 , Giovanni Battista Migliori  42 , Greta Mino  43 , Emmanuel Nsutebu  44 , Natalia Pshenichnaya  45 , Nida Qadir  46 , Shalini Sri Ranganathan  47 , Saniya Sabzwari  27 , Rohit Sarin  48 , Manu Shankar-Hari  49 , Michael Sharland  50 , Yinzhong Shen  51 , Joao Paulo Souza  52 , Tshokey Tshokey  53 , Sebastian Ugarte  54 , Tim Uyeki  55 , Sridhar Venkatapuram  49 , Ablo Prudence Wachinou  56 , Ananda Wijewickrama  57 , Dubula Vuyiseka  58 , Jacobus Preller  9   2 , Romina Brignardello-Petersen  6   2 , Elena Kum  6   2 , Anila Qasim  6   2 , Dena Zeraatkar  6   2 , Andrew Owen  59   2 , Gordon Guyatt  6   8   2 , Lyubov Lytvyn  6   2 , Michael Jacobs  60   2   61 , Per Olav Vandvik  7   62   2   61 , Janet Diaz  9   46   2   61
Affiliations
Practice Guideline

A living WHO guideline on drugs to prevent covid-19

François Lamontagne et al. BMJ. .

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. The first version of this living guideline focuses on the evidence for hydroxychloroquine. Subsequent updates will cover other drugs being investigated for their role in the prevention of covid-19.

Recommendation: The guideline development panel made a strong recommendation against the use of hydroxychloroquine for individuals who do not have covid-19 (high certainty).

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) provided methodological support. A living systematic review with network analysis informed the recommendations. An international guideline development panel of content experts, clinicians, patients, an ethicist and methodologists produced recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Understanding the new recommendation: The linked systematic review and network meta-analysis (6 trials and 6059 participants) found that hydroxychloroquine had a small or no effect on mortality and admission to hospital (high certainty evidence). There was a small or no effect on laboratory confirmed SARS-CoV-2 infection (moderate certainty evidence) but probably increased adverse events leading to discontinuation (moderate certainty evidence). The panel judged that almost all people would not consider this drug worthwhile. In addition, the panel decided that contextual factors such as resources, feasibility, acceptability, and equity for countries and healthcare systems were unlikely to alter the recommendation. The panel considers that this drug is no longer a research priority and that resources should rather be oriented to evaluate other more promising drugs to prevent covid-19.

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 first version of the living guideline for drugs to prevent covid-19. It complements the WHO living guideline on drugs to treat covid-19. When citing this article, please consider adding the update number and date of access for clarity.

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Conflict of interest statement

Competing interests: All guideline panel members have completed the WHO interest disclosure form. All authors have completed the BMJ Rapid Recommendations interest of disclosure form. The WHO, MAGIC, and The BMJ judged that no panel member had any financial conflict of interest. Professional and academic interests are minimised as much as possible, while maintaining necessary expertise on the panel to make fully informed decisions. MAGIC and TheBMJ assessed declared interests from other co-authors of this publication and found no conflicts of interests.

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