中美新型冠状病毒肺炎诊疗指南用药对比

Comparison of the Use of Therapeutic Drugs in the COVID-19 Diagnosis and Treatment Guidelines Issued by China and the United States

目的为我国新型冠状病毒肺炎(简称新冠肺炎)诊疗指南中该病治疗药物的选择提供参考。方法解读美国国立卫生研究院《新型冠状病毒肺炎治疗指南》(简称NIH指南),并按涉及新冠肺炎治疗药物的作用机制分类,总结相应药物的推荐情况、适应证适用人群和用法用量,并与我国发布的《新型冠状病毒肺炎诊疗方案(试行第九版)》(简称诊疗方案)和《中国成人2019冠状病毒病的诊治与防控指南》(简称诊治指南)收载用药进行对比。结果NIH指南推荐使用3个抗病毒药物(瑞德西韦、Paxlovid、莫努匹韦)、1个单克隆抗体药物(Bebtelovimab)、4个皮质类固醇(地塞米松、泼尼松、甲泼尼龙和氢化可的松)、2个白细胞介素6抑制剂(托珠单抗、沙利鲁单抗)和2个Janus激酶抑制剂(巴瑞替尼、托法替尼)。我国的诊疗方案、诊治指南与之相比存在一定差异,尤其体现在抗病毒药物、单克隆抗体药物和白细胞介素6抑制剂(沙利鲁单抗)的选择上。结论我国应继续推进新冠肺炎治疗药物的临床研究,加快国内外相应治疗药物的应急批准,同时在后续版本指南的修订中及时完善并更新用药方案,以便为临床用药提供指导。

Objective To provide a reference for the selection of therapeutic drugs for the treatment of coronavirus disease 2019(COVID-19)in the COVID-19 Diagnosis and Treatment Guidelines in China.Methods The National Institutes of Health's COVID-19 Treatment Guidelines(hereinafter referred to as the NIH Guidelines)were interpreted,the COVID-19 therapeutic drugs were classified according to their action mechanism,and the recommendation,indication,applicable population,usage and dosage of corresponding drugs were summarized.The use of drugs in the NIH Guidelines was compared with that in COVID-19 Diagnosis and Treatment Plan(Trial Version 9,hereinafter referred to as the Diagnosis and Treatment Plan)and the Guidelines for the Diagnosis,Treatment and Prevention of COVID-19 in Adults in China(hereinafter referred to as the Diagnosis and Treatment Guidelines).Results The NIH Guidelines recommended three antiviral drugs(remdesivir,paxlovid,molnupiravir),one monoclonal antibody drug(bebtelovimab),four corticosteroids(dexamethasone,prednisone,methylprednisolone and hydrocortisone),two interleukin-6 inhibitors(tocilizumab and sarilumab),and two Janus kinase inhibitors(baricitinib and tofacitinib).There were some differences in the Diagnosis and Treatment Plan and the Diagnosis and Treatment Guidelines in China,especially in the selection of antiviral drugs,monoclonal antibody drugs and interleukin-6 inhibitors(sarilumab).Conclusion China should continue to promote the clinical research of the drugs for the treatment of COVID-19,accelerate the emergency approval of the corresponding drugs at home and abroad,and timely improve and update the medication plan in the subsequent revision of the guidelines,in order to provide guidance for clinical medication.