Quality and methodology of clinical practice guidelines on antiviral pharmacotherapy for COVID-19 during the early phase of the pandemic

Abstract

Introduction Despite the availability of reliable methods for guideline development, the risk of producing less reliable documents may be higher when the guidelines are developed rapidly. Objectives The aim of this study was to evaluate the quality of guidelines on COVID-19, developed in the early stages of the COVID-19 pandemic, and to assess whether recommendations for pharmacotherapy were supported by evidence. methods We performed the search for documents that considered antiviral therapies and contained recommendations for clinicians. The quality of the guidelines was assessed using the Appraisal of Guidelines for Research and Evaluation II-Global Rating Scale (AGREE II-GRS) instrument and a series of additional criteria. Results The analysis included 40 publications. The median (interquartile range) quality of documents assessed with the AGREE II-GRS tool was 2 (1.5-2.5). Most documents did not fulfill the rigor of guideline development quality criteria. The AGREE II-GRS scores did not differ across the type of the document, endorsing body, and mode of publication. Seventy-five percent of documents provided recommendations for the use of antiviral medications despite the apparent lack of sufficient evidence supporting such treatments. Of the included documents, 75% were not updated within the 2 months following the publication of the first randomized controlled trial on COVID-19 antiviral therapy. Conclusions Most guidelines or guidance documents published during the early phase of the COVID-19 pandemic were of poor quality, contained recommendations for the use of antiviral therapy for SARS-CoV-2 infection despite only very low quality of evidence available, and were not updated on a regular basis.