As the world continues to emerge from the pandemic, new and ongoing research continues to inform clinical trials and treatment guidelines in COVID-19 critical care.
During the session Clinical Trial Updates in COVID-19 Critical Care, a panel of experts will discuss evidence-based updates in strategic areas of interest that impact the entire disease spectrum for COVID-19. The session will be held on Monday, October 17, from 11:00 AM – 12:00 PM CT, in Davidson A2-A3.
“Our objective in this session is to recap some of the important things we’re learning in the critical care of COVID patients, such as options for antiviral and monoclonal antibody therapy, the role of antiinflammatory agents, and updates regarding anticoagulation in patients with COVID-19,” said Session Chair, Steven Q. Simpson, MD, FCCP, professor of medicine in the division of pulmonary, critical care, and sleep medicine at the University of Kansas and Immediate Past President of CHEST.
Dr. Simpson, who is a member of the National Institutes of Health (NIH) COVID-19 Treatment Guidelines panel, will open the session with a review of the latest guideline updates.
“We recently published some important updates on the prevention and management of COVID-19 in immunocompromised patients and on some of the unique considerations related to the clinical management of COVID-19 in both hospitalized and nonhospitalized children,” Dr. Simpson said.
He will also discuss the impact of the pandemic on the design and execution of clinical trials in critical care.
“The COVID pandemic represents a change in how we’re seeing, and will continue to see, randomized controlled trials in critical care being performed,” Dr. Simpson said. “There have been multiple adaptive platform trials that have allowed us to get some important answers. This adaptive trial concept has been around a while in the oncology realm, but it’s new to critical care.”
Joining Dr. Simpson for this session is Heather Torbic, PharmD, medical intensive care unit clinical specialist at the Cleveland Clinic, who will discuss anticoagulation in patients with COVID-19.
“Anticoagulation has been a hot topic from the get-go because we’ve seen that D-dimer levels are commonly increased and platelet counts tend to decrease in COVID-19 patients, and, although it has not been fully demonstrated yet, many clinicians believe they are seeing more thromboembolic events in COVID than in other critical illnesses,” Dr. Simpson said. “As of right now, however, NIH guidelines are still recommending that you use standard prophylactic anticoagulation unless you diagnose a thromboembolic event.”
Greg Martin, MD, FCCP, professor of medicine and executive associate division director of pulmonary, allergy, critical care, and sleep medicine at Emory University in Atlanta, will follow with a discussion of the role and timing of antiinflammatory therapy in patients with COVID-19.
“Multiple antiinflammatories have been looked at, and corticosteroids have been demonstrated to be the most effective and [are] the principal [ones] we use,” Dr. Simpson said. “Anti-TNF and anti-IL6 antibodies also have demonstrated some effect, and some newer trials of antiinflammatories will likely provide some supporting or confirmatory evidence on which agents might be most effective in critically ill COVID patients.”
John Beigel, MD, associate director for clinical research in the division of microbiology and infectious diseases at the National Institute of Allergy and Infectious Diseases, will conclude the session with a look at recent findings regarding antiviral and monoclonal antibody therapies in patients with COVID-19.
“Interestingly, the use of convalescent plasma as an antiviral in COVID-19 patients is a bit of a tempest in a teapot, with some people believing we should be doing it for outpatients and others thinking that it’s overkill,” Dr. Simpson said. “Some important new findings are emerging in this area, and there will likely be an update soon to the NIH guidelines about using intravenous immune globulins.”