Comparative efficacy and safety of pharmacological interventions for the treatment of COVID-19: A systematic review and network meta-analysis of confounder-adjusted 20212 hospitalized patients

Our analysis showed that hydroxychloroquine was significantly associated with reduced time to viral clearance

Kim

2020

Scholarcy highlights

  • A large registry-based study investigating the effect of hydroxychloroquine on COVID-19 patients reported surprisingly high mortality rate and ventricular arrhythmia incidence with hydroxychloroquine use, and this paper contributed to the decision of the World Health Organization to pause all ongoing trials on hydroxychloroquine due to safety concerns
  • The risk of progression to severe pneumonia or ICU admission was significantly reduced with tocilizumab, anakinra, and remdesivir compared to standard care
  • Tocilizumab was shown to reduce mortality rate for both moderate-severe patients in the non-ICU setting at admission 0.31, 95% confidence interval and critically ill patients in the ICU setting
  • Convalescent plasma and hydroxychloroquine were shown to promote viral clearance while not altering mortality or progression to the severe courses
  • The combination of hydroxychloroquine and azithromycin was shown to be associated with increased QT prolongation incidence and fatal cardiac complications in cardiac-impaired populations
  • Treatment with hydroxychloroquine plus azithromycin showed a significant association while others did not
  • It could be argued that the frequent use of corticosteroids on patients with more severe conditions may have skewed the results against corticosteroid use; the studies included in our synthesis have adjusted for confounders for mortality including severity of disease, implicating that the observed unsafe effect of corticosteroids in critically ill COVID-19 should not be neglected
  • 20% of current evidence on pharmacological management of COVID-19 is on moderate/high evidence certainty and can be considered in practice and policy; remaining 80% are of low or very low certainty and warrant further studies to establish firm conclusions

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