Question 8. what is the optimal treatment duration?
In the absence of proven effective treatment, treatment duration also remains unclear; it is currently based on expert opinion which is based on treatment durations in other approved indications for the drugs provided and aimed at a balance between potential activity and risk of undesired side effects. Nonetheless, suggested durations vary markedly. For example, a wide range of chloroquine/hydroxychloroquine treatment durations (from 5 to 20 days) have been recommended/provided in different centres/studies, making it impossible to provide an univocal recommendation in the absence of direct comparisons of different lengths of treatment with regard to relevant clinical endpoints (e.g. mortality, ICU admission) and safety [33,40,41,[83], [84], [85]]. There is no standard steroid treatment duration, with different consensus/study groups suggesting steroid administration for no longer than 7 to 10 days [54,85].

Question 8 statement
Chloroquine/hydroxychloroquine treatment should be continued for at least 5 days and possibly prolonged up to 20 days according to some expert opinions, although it should be noted that data regarding the relative safety of different lengths of administration in COVID-19 patients are currently unavailable. Early discontinuation should be considered in the presence of adverse effects (e.g. QT prolongation or hepatic/renal toxicity; Table 3). If the administration of remdesivir is approved within compassionate-use/expanded-access programmes, treatment duration should follow compassionate or expanded access protocols (e.g. up to 10 days according to the most recent compassionate protocol at the time of this review). If corticosteroids are administered, we suggest a total treatment duration of 7 to 10 days, with progressive dose reduction. If the patient deteriorates with worsening lung physiology after removal of steroid treatment in the absence of bacterial or fungal superinfection, a second course of corticosteroid treatment may be considered, followed by slow tapering after improvement.