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Abdelrahman Z, Liu Q, Jiang S, et al. Evaluation of the Current Therapeutic Approaches for COVID-19: A Systematic Review and a Meta-analysis. Front Pharmacol. 2021 Mar 15;12:607408. doi: 10.3389/fphar.2021.607408. eCollection 2021. (Systematic review)
Abstract

Background: Limited data on the efficacy and safety of currently applied COVID-19 therapeutics and their impact on COVID-19 outcomes have raised additional concern. Objective and Methods: To estimate the efficacy and safety of COVID-19 therapeutics, we performed meta-analyses of the studies reporting clinical features and treatments of COVID-19 published from January 21 to September 6, 2020. Results: We included 136 studies that involved 102,345 COVID-19 patients. The most prevalent treatments were antibiotics (proportion: 0.59, 95% CI: [0.51, 0.67]) and antivirals (proportion: 0.52, 95% CI: [0.44, 0.60]). The combination of lopinavir/ritonavir and Arbidol was the most effective in treating COVID-19 (standardized mean difference (SMD) = 0.68, 95% CI: [0.15, 1.21]). The use of corticosteroids was associated with a small clinical improvement (SMD = -0.40, 95% CI: [-0.85, -0.23]), but with a higher risk of disease progression and death (mortality: RR = 9.26, 95% CI: [4.81, 17.80]; hospitalization length: RR = 1.54, 95% CI: [1.39, 1.72]; severe adverse events: RR = 2.65, 95% CI: [2.09, 3.37]). The use of hydroxychloroquine was associated with a higher risk of death (RR = 1.68, 95% CI: [1.18, 2.38]). The combination of lopinavir/ritonavir, ribavirin, and interferon-ß (RR = 0.34, 95% CI: [0.22, 0.54]); hydroxychloroquine (RR = 0.58, 95% CI: [0.39, 0.58]); and lopinavir/ritonavir (RR = 0.72, 95% CI: [0.56, 0.91]) was associated with reduced hospitalization length. Hydrocortisone (RR = 0.05, 95% CI: [0.03, 0.10]) and remdesivir (RR = 0.74, 95% CI: [0.62, 0.90]) were associated with lower incidence of severe adverse events. Dexamethasone was not significant in reducing disease progression (RR = 0.45, 95% CI: [0.16, 1.25]) and mortality (RR = 0.90, 95% CI: [0.70, 1.16]). The estimated combination of corticosteroids with antivirals was associated with a better clinical improvement than antivirals alone (SMD = -1.09, 95% CI: [-1.64, -0.53]). Conclusion: Antivirals are safe and effective in COVID-19 treatment. Remdesivir cannot significantly reduce COVID-19 mortality and hospitalization length, while it is associated with a lower incidence of severe adverse events. Corticosteroids could increase COVID-19 severity, but it could be beneficial when combined with antivirals. Our data are potentially valuable for the clinical treatment and management of COVID-19 patients.

Ratings
Discipline Area Score
Emergency Medicine 7 / 7
Pediatric Hospital Medicine 7 / 7
Respirology/Pulmonology 6 / 7
Infectious Disease 6 / 7
Hospital Doctor/Hospitalists 5 / 7
Internal Medicine 5 / 7
Pediatric Emergency Medicine 5 / 7
Intensivist/Critical Care 4 / 7
Comments from MORE raters

Emergency Medicine rater

This article attempts to meta analyze multiple different studies with significant heterogeneity, different enrollment criteria, and then comes to conclusions that are not supported by their own statistics. This is not a well done study with results that run contrary to most of the available high quality data.

Emergency Medicine rater

It’s a pretty good article reviewing this important topic. Already all we know that the most efficient treatments are from no more than 4 groups headed by monoclonal antibody.

Intensivist/Critical Care rater

We still need to collect further information with more promising and effective medicine.

Intensivist/Critical Care rater

This study brings an analysis of several interventions for COVID-19, but there is an important evidence gap in the safety and and potential effect in outcome of drugs purposed for COVID-19.

Internal Medicine rater

Shooting at a moving target, the authors report on studies published through Sept 6, 2020. This is a long time in the world of Covid-19 treatments. I would not rely on this for current advice.

Pediatric Emergency Medicine rater

Not relevant for PEM.

Respirology/Pulmonology rater

This is a systematic review and network meta-analysis of current evidence about COVID-19 treatments. This is a rapidly evolving area and further updates will be needed soon to keep apace with developments.
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