Nutritional Advice El MondoObjectives:
Numerous clinical trials and observational studies have investigated various pharmacological agents as potential treatment for Coronavirus Disease 2019 (COVID-19), but the results are heterogeneous and sometimes even contradictory to one another, making it difficult for clinicians to determine which treatments are truly effective. Therefore, this review article has been conducted.
What is the comparative efficacy and safety of pharmacological interventions for the treatment of COVID-19 and the level of evidence behind each treatment regimen in different clinical settings?
Study design:
This review article included 40 RCTs and 70 confounding-adjusted observational studies.
The quality of evidence of collective outcomes was estimated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. The major limitation of the present review article is the overall low level of evidence that reduces the certainty of recommendations. Besides, the risk of bias (RoB) measured by RoB2 and ROBINS-I framework for individual studies was generally low to moderate. The outcomes deducted from observational studies could not infer causality and can only imply associations.
Results and conclusions:
The investigators found based on RCTs, progression to severe course was associated with a significantly reduced risk of 77% for corticosteroids [OR = 0.23, 95% CI = 0.06 to 0.86, p = 0.032] when compared to standard care for moderate to severe COVID-19 patients in non-ICU.
The investigators found based on RCTs, mortality was associated with a significantly reduced risk of 22% for corticosteroids [OR = 0.78, 95% CI = 0.66 to 0.91, p = 0.002] when compared to standard care for moderate to severe COVID-19 patients in non-ICU.
Corticosteroids were also shown to reduce mortality rate [OR = 0.54, 95% CI = 0.40 to 0.73, p 0.001] for critically ill patients in ICU.
The investigators found based on RCTs, progression to severe course was associated with a significantly reduced risk of 71% for remdesivir [OR = 0.29, 95% CI = 0.17 to 0.50, p 0.001] when compared to standard care for moderate to severe COVID-19 patients in non-ICU.
The investigators found based on RCTs, mortality was associated with a significantly reduced risk of 38% for remdesivir [OR = 0.62, 95% CI = 0.39 to 0.98, p = 0.041] when compared to standard care for moderate to severe COVID-19 patients in non-ICU.
The investigators found in analyses including observational studies, interferon-alpha [OR = 0.05, 95% CI = 0.01 to 0.39, p = 0.004], itolizumab [OR = 0.10, 95% CI = 0.01 to 0.92, p = 0.042], sofosbuvir plus daclatasvir [OR = 0.26, 95% CI = 0.07 to 0.88, p = 0.030], anakinra [OR = 0.30, 95% CI = 0.11 to 0.82, p = 0.019], tocilizumab [OR = 0.43, 95% CI = 0.30 to 0.60, p 0.001] and convalescent plasma [OR = 0.48, 95% CI = 0.24 to 0.96, p = 0.038] were associated with reduced mortality rate in non-ICU setting.
The investigators found in analyses including observational studies, high-dose intravenous immunoglobulin (IVIG) [OR = 0.13, 95% CI = 0.03 to 0.49, p = 0.003], ivermectin [OR = 0.15, 95% CI = 0.04 to 0.57, p = 0.005] and tocilizumab [OR = 0.62, 95% CI = 0.42 to 0.90, p = 0.012] were associated with reduced mortality rate in critically ill patients.
The investigators found in analyses including observational studies, convalescent plasma was the only treatment option that was associated with improved viral clearance rate at 2 weeks compared to standard care [OR = 11.39, 95% CI = 3.91 to 33.18, p 0.001].
The investigators found in analyses including observational studies, the combination of hydroxychloroquine and azithromycin was shown to be associated with increased QT prolongation incidence [OR = 2.01, 95% CI = 1.26 to 3.20, p = 0.003] and fatal cardiac complications in cardiac-impaired populations [OR = 2.23, 95% CI = 1.24 to 4.00, p = 0.007].
The investigators found no drug was significantly associated with increased noncardiac serious adverse events compared to standard care.
The investigators concluded that anti-inflammatory agents (corticosteroids, tocilizumab, anakinra and IVIG), convalescent plasma and remdesivir are associated with improved outcomes of hospitalized COVID-19 patients. Hydroxychloroquine does not provide clinical benefits while posing cardiac safety risks when combined with azithromycin, especially in the vulnerable population. Only 29% of current evidence on pharmacological management of COVID-19 is supported by moderate or high certainty and can be translated to practice and policy; the remaining 71% are of low or very low certainty and warrant further studies to establish firm conclusions.
Original title:
Comparative efficacy and safety of pharmacological interventions for the treatment of COVID-19: A systematic review and network meta-analysis by Kim MS, An MH, […], Hwang TH.
Link:
https://pubmed.ncbi.nlm.nih.gov/33378357/
Additional information of El Mondo:
Find more information/studies on coronavirus right here.