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

In this network meta-analysis, we found that anti-inflammatory agents ), convalescent plasma, and remdesivir were associated with improved outcomes of hospitalized COVID-19 patients

Min Seo Kim; Min Ho An; Won Jun Kim; Tae-Ho Hwang

2020

Scholarcy highlights

  • Numerous Coronavirus Disease 2019 clinical trials and observational studies are underway, and over 47 pharmacological agents and regimens have been investigated as potential treatments of COVID-19
  • Based on randomized controlled trial, the risk of progression to severe course and mortality was significantly reduced with corticosteroids 0.23, 95% confidence interval 0.06 to 0.86, p = 0.032, and odds ratios 0.78, 95% confidential intervals and remdesivir compared to standard care for moderate to severe COVID-19 patients in non-intensive care unit; corticosteroids were shown to reduce mortality rate for critically ill patients in ICU
  • The study protocol is publicly available on PROSPERO. In this network meta-analysis, we found that anti-inflammatory agents, convalescent plasma, and remdesivir were associated with improved outcomes of hospitalized COVID-19 patients
  • Hydroxychloroquine did not provide clinical benefits while posing cardiac safety risks when combined with azithromycin, especially in the vulnerable population
  • In the whole dataset, including data from RCTs and observational studies, anti-inflammatory agents, convalescent plasma, and remdesivir were associated with improved clinical outcomes of COVID-19
  • For moderate and severe patients hospitalized in non-ICU settings, corticosteroids, tocilizumab, anakinra, remdesivir, and convalescent plasma were associated with reduced risk of progression to severe pneumonia, admission to ICU, and/or mechanical ventilation
  • 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

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