COVID-19 is considered the biggest health crisis in the world today, which led to a worldwide race to find treatment for the disease. The cycle of drug discovery and development is long, so existing drugs are being tested. The clamor for speed in treatment options, with publication of the produced evidence at ‘real time’ had an impact on the recommendations for the use of medicines against COVID 19. In the case of Brazil, how was this? Our research questions were: are the Brazilian government treatment recommendations in agreement with the evidence in the literature regarding the use of the drugs chloroquine, hydroxychloroquine in patients with COVID-19? Did the recommendations accompany the generation of evidence and change along with them?
Material and methods:
It was associated with a scope review of the scientific literature throughout 2020, an evaluation of recommendations and treatment protocols issued by Brazilian government agencies and medical societies (SBI and SBPT).
Databases: Lilacs, Embase and PubMed. For technical recommendations: government websites. And both societies SBI and SBPT websites. Period: January to November 2020. Study design: SR and CT.
The most frequent official publications were technical notes and information notes. There have been only few clinical treatment protocols. Among the official agencies evaluated, 7 published changes to the recommendation on treatment during the period of time evaluated. Regarding the scientific literature, 3122 articles were found. In the final phase, 34 articles were analyzed: 3 CTs and 31 SR, 18 with meta-analysis. Of the total, 11 were published in the first half of 2020 and 24 in the second. One was exclusively about Chloroquine, the rest had Hydroxychloroquine as a drug of interest. In April, recommendations from the MH of Brazil, all 26 states and the DF. Also, SBI had recommendation produced together with the SBPT.
Regarding CQ and HCQ, the literature indicates ineffectiveness of the 2 drugs in the treatment of COVID-19 and relevant safety aspects. The MS and 9 states have their own treatment recommendations and 18 states recommend following the MS. There was no correlation between the official recommendations and the scientific literature, except in the SBI + SBPT material. HTA is essential at times like these, to allow the construction of recommendations and policies consistent with the best available scientific evidence and the country's needs.
Monica Vinhas de Souza
Igor, muito obrigada pelo comentário.
Quando iniciamos o trabalho pensamos em avaliar os antimaláricos e a ivermectina, mas naquele momento havia pouquíssima evidência para ivermectina.
Elas aumentaram ao longo da 2a metade do 2o semestre, quando estávamos terminando a 1a versão (este trabalho foi originalmente um TCC apresentado em dezembro).
É uma ótima sugestão, vamos pensar em acrescentar na publicação. Obrigada!