Panel recommends new SARS guidelines

WHO offers standards for analyzing treatments

October 26, 2003|By NEW YORK TIMES NEWS SERVICE

A scientific panel convened by the World Health Organization has recommended guidelines for doctors conducting clinical studies of SARS patients.

The panel urged doctors to apply the guidelines in analyzing the mounds of potentially useful information about various therapies that were collected in this year's epidemic of severe acute respiratory syndrome. Much of that information has not been published or analyzed.

It "is a matter of urgency to get better analysis and review," said Dr. Simon Mardel, a WHO official who led the two-day meeting that ended Friday. He said thousands of potential therapies and compounds had been tested as researchers tried to determine treatments for SARS.

"We recognize that having no treatment for SARS is hindering our ability to control an epidemic in so many ways," Mardel said by telephone from Geneva.

In the epidemic this year, various treatments - including drugs to fight the virus or strengthen the immune system, as well as traditional Chinese medicine - were delivered under emergency conditions, in widely different settings and countries, to patients suffering from varying stages of the illness. Those conditions - generally without standardized measurements or controlled situations - have made it hard to interpret results.

Standard supportive therapy like nursing, and in severe cases the use of mechanical respirators to help patients breathe, is the mainstay of SARS care, and it helped many patients survive.

But doctors still do not know how best to treat SARS patients who have breathing difficulties, Mardel said. One method is invasive ventilation, in which a patient is connected to a ventilator through a tube inserted in the windpipe, a procedure that generally requires sedation and temporary paralysis. A second method is noninvasive: A mask is fitted over the face, and oxygen is blown into the lungs. Both carry the risk of transmitting the virus to hospital employees.

Without proper analysis, the panel could not say definitively which treatment worked best, or which caused the most harm.

The panel also agreed on guidelines that would allow doctors to conduct quick and safe clinical trials, a process that generally takes years to define and complete. The World Health Organization, a United Nations agency, did not release the guidelines.

Experts in many countries have listed the treatments they want to test, and the health agency is leaving those decisions to individual nations.

Among the controversies that emerged from this year's epidemic are the safety and effectiveness of ribavirin, an anti-viral drug, and steroids. Additional treatments that many doctors want to test include the portion of blood that includes antibodies, which some doctors believe help patients recover. But such antibody therapy, known as passive immunization, is also risky. Studies have not determined the relative benefit and risks of passive immunization for SARS.

During the epidemic in April, the Chinese State Academy of Traditional Chinese Medicine identified eight regimens that it deemed most suitable for SARS, Mardel said. Most SARS patients received traditional medicine in various regimens that included a range of ingredients, and took into account each patient's earlier response to SARS, Mardel said. For many patients, traditional medicine, including herbs, was their only treatment for SARS; for many others, it was integrated with Western medicines. Such care created a large number of permutations.

In Beijing two weeks ago, Chinese experts tried to analyze findings from 13 studies of traditional Chinese medicine.

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