Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSPLAMONTAGNE, FrancoisAGORITSAS, ThomasSIEMIENIUK, ReedROCHWERG, BramBARTOSZKO, JessicaASKIE, LisaMACDONALD, HelenAMIN, WagdyBAUSCH, Frederique JacqueriozBURHAN, ErlinaCECCONI, MaurizioCHANDA, DuncanVu Quoc DatDU, BinGEDULD, HeikeGEE, PatrickNERINA, HarleyHASHIMI, MadihaHUNT, Beverley J.KABRA, SushilKANDA, SeemaKAWANO-DOURADO, LeticiaKIM, Yae-JeanKISSOON, NiranjanKWIZERA, ArthurLEO, Yee-SinMAHAKA, ImeldaMANAI, HelaMINO, GretaNSUTEBU, EmmanuelPSHENICHNAYA, NataliaQADIR, NidaRANGANATHAN, Shalini SriSABZWARI, SaniyaSARIN, RohitSHARLAND, MichaelSHEN, YinzhongSOUZA, Joao PauloSTEGEMANN, MiriamUGARTE, SebastianVENKATAPURAM, SridharVUYISEKA, DubulaPRELLER, JacobusBRIGNARDELLO-PETERSEN, RominaKUM, ElenaQASIM, AnilaZERAATKAR, DenaOWEN, AndrewGUYATT, GordonLYTVYN, LyubovDIAZ, JanetVANDVIK, Per OlavJACOBS, Michael2021-04-152021-04-152021BMJ-BRITISH MEDICAL JOURNAL, v.372, article ID n526, 5p, 20211756-1833https://observatorio.fm.usp.br/handle/OPI/40171CLINICAL 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. Drugs could be used as prophylaxis to prevent covid-19 developing in those who are free from disease. Such drugs complement vaccines that, through developing immune responses to SARS-Cov-2, reduce the risk of developing covid-19 and its consequences. Drugs to prevent covid-19 could target whole populations, those at higher risk of becoming infected with SARS-CoV-2 (due to their work, social circumstances, or a particular exposure), or those at higher risk of death and poor outcomes if infected. There are 2610 trials investigating various drug interventions for covid-19 (see section on emerging evidence).1 This rapidly evolving evidence landscape requires trustworthy interpretation and expeditious clinical practice guidelines to inform clinicians, patients, governments, ministries and health administrators. This living guideline uses emerging evidence from RCTs on drugs to prevent covid-19 and complements the livingWHOguideline on drugs to treat covid-19.(2) The living network meta-analysis associated with this guideline will incorporate new trial data and allow for analysis of comparative effectiveness.3 Details of the network meta-analysis and other related publications are listed in box 1. We will also use additional relevant evidence on long term safety, prognosis, and patient values and preferences related to covid-19 treatments to inform the living guidance.engrestrictedAccessarticleCopyright BMJ PUBLISHING GROUP10.1136/bmj.n526Medicine, General & Internal