Mentre impazza la corsa ai vaccini e i governi le stanno mettendo in campo di tutti i colori per introdurre un illegittimo obbligo, più seriamente l’autorevole ‘British Medical Journal’pubblica un lungo articolo che illustra l’utilità delle cure per fronteggiare il Covid-19.
Parliamo di quelle cure, di quei farmaci fin dall’inizio osteggiati, boicottati e delegittimati con tutti i mezzi possibili dai governi di vari paesi europei. In primo luogo il nostro, che attraverso il suo ministro per la Salute Roberto Speranza ha indicato agli italiani una unica e sola via in attesa messianica dei vaccini: “tachipirina e vigile attesa”, questo il folle percorso terapeutico indicato. E guai a quei medici che osavano prescrivere quelle cure, quei farmaci fuorilegge. Come, per fare i due esempi più clamorosi, l’Idrossiclorochina el’Invermectina.
C’è voluta addirittura un’ordinanza del Consiglio di Stato, varata il 12 dicembre 2020, per sdoganare l’uso dell’idrossiclorochina, e far in modo che i medici di famiglia me potessero prescrivere l’uso come validissima cura d’urto contro il Covid incipiente.
Un farmaco che ha anche un altro grosso difetto, o meglio due: è in commercio da anni (viene ritualmente usato contro l’artrosi) e quindi è reperibile in tutte le farmacie; e, soprattutto, è molto economico, quindi non consente grossi utili alle case farmaceutiche. Quelle aziende impegnate, invece, nella stramiliardaria corsa ai vaccini, che – lo ribadiamo per l’ennesima volta – sono del tutto sperimentali, perché i test base termineranno solo a dicembre 2013, quindi fra due anni e mezzo. Per adesso le cavie siamo noi.
E’ stato (ed è ancora) quindi delittuoso negare l’accesso ai farmaci anti covid: di tale reato (strage) dovranno rispondere le autorità scientifiche (sic) e politiche che hanno impedito le cure e costretto migliaia e migliaia di cittadini ai ricoveri, alle drammatiche intubazioni e, in moltissimi casi, alla morte, come tragicamente mostrano le nostre ‘performance’ (sic) a livello europeo.
Ecco, di seguito, cosa scrive il ‘British Medical Journal’. Il testo, ovviamente, è in inglese.
A living WHO guideline on drugs for covid-19
Abstract
Clinical question What is the role of drug interventions in the treatment of patients with covid-19?
New recommendation The publication of the RECOVERY and REMAP-CAP randomised controlled trials triggered this guideline update, resulting in a strong recommendation for interleukin-6 (IL-6) receptor blockers (tocilizumab or sarilumab) in patients with severe or critical covid-19.
Prior recommendations (a) A recommendation not to use ivermectin in patients with covid-19, regardless of disease severity, except in the context of a clinical trial; (b) a strong recommendation against the use of hydroxychloroquine in patients with covid-19, regardless of disease severity; (c) a strong recommendation against the use of lopinavir-ritonavir in patients with covid-19, regardless of disease severity; (d) a strong recommendation for systemic corticosteroids in patients with severe and critical covid-19; (e) a conditional recommendation against systemic corticosteroids in patients with non-severe covid-19; and (f) a conditional recommendation against remdesivir in hospitalised patients with covid-19.
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 meta-analysis informed the recommendations. For IL-6 receptor blockers, a complementary prospective meta-analysis informed the outcome of mortality. 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 panel judged that almost all well informed patients would want to receive IL-6 receptor blockers (tocilizumab and sarilumab) for severe and critical covid-19, given that there was high certainty evidence of benefit for mortality and mechanical ventilation, the two most important outcomes for patients. In addition to the network analysis, a direct comparison from REMAP-CAP provided evidence that tocilizumab and sarilumab had similar effects on the main outcomes of interest. There is ongoing uncertainty about serious adverse events and bacterial infections related to IL-6 receptor blockers. The panel recognised important resources and access issues around IL-6 receptor blockers.
Updates This is a living guideline. It replaces earlier versions (4 September, 20 November, 17 December 2020, and 31 March 2021) and supersedes the BMJ Rapid Recommendations on remdesivir published on 2 July 2020. The previous versions can be found as data supplements. New recommendations will be published as updates to this guideline.
Readers note This is the fifth version (update 4) of the living guideline (BMJ 2020;370:m3379). When citing this article, please consider adding the update number and date of access for clarity.
This living guideline responds to emerging evidence from randomised controlled trials (RCTs) on existing and new drug treatments for covid-19. Although case numbers are falling in some regions, they are rising in others. Vaccines are linked to falling case numbers and hospitalisations, but it is unclear how long protection following vaccination or natural infection will last, or how this might alter with the emergence of new variants. Therefore, the potential for drugs to treat people infected with covid-19 remains of interest and is the focus of this guideline. A linked guideline addresses the role of drugs in the prevention of covid-19 among people who are not infected.1
More than 3800 trials on covid-19 interventions have been registered or are ongoing (see section on emerging evidence2). Among these are large national and international platform trials (such as RECOVERY, WHO SOLIDARITY, REMAP-CAP, and ACTIV) that recruit large numbers of patients in many countries, with pragmatic and adaptive designs.3456 These platform trials are currently investigating and reporting on numerous interventions, including antiviral monoclonal antibodies and immunomodulators. This rapidly evolving evidence landscape requires trustworthy interpretation and expeditious clinical practice guidelines to inform clinicians and healthcare decision makers.
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