Cargando…
Evaluation of the Current Therapeutic Approaches for COVID-19: A Systematic Review and a Meta-analysis
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 reportin...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005525/ https://www.ncbi.nlm.nih.gov/pubmed/33790785 http://dx.doi.org/10.3389/fphar.2021.607408 |
_version_ | 1783672125630971904 |
---|---|
author | Abdelrahman, Zeinab Liu, Qian Jiang, Shanmei Li, Mengyuan Sun, Qingrong Zhang, Yue Wang, Xiaosheng |
author_facet | Abdelrahman, Zeinab Liu, Qian Jiang, Shanmei Li, Mengyuan Sun, Qingrong Zhang, Yue Wang, Xiaosheng |
author_sort | Abdelrahman, Zeinab |
collection | PubMed |
description | 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-β (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. |
format | Online Article Text |
id | pubmed-8005525 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-80055252021-03-30 Evaluation of the Current Therapeutic Approaches for COVID-19: A Systematic Review and a Meta-analysis Abdelrahman, Zeinab Liu, Qian Jiang, Shanmei Li, Mengyuan Sun, Qingrong Zhang, Yue Wang, Xiaosheng Front Pharmacol Pharmacology 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-β (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. Frontiers Media S.A. 2021-03-15 /pmc/articles/PMC8005525/ /pubmed/33790785 http://dx.doi.org/10.3389/fphar.2021.607408 Text en Copyright © 2021 Abdelrahman, Liu, Jiang, Li, Sun, Zhang and Wang. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Pharmacology Abdelrahman, Zeinab Liu, Qian Jiang, Shanmei Li, Mengyuan Sun, Qingrong Zhang, Yue Wang, Xiaosheng Evaluation of the Current Therapeutic Approaches for COVID-19: A Systematic Review and a Meta-analysis |
title | Evaluation of the Current Therapeutic Approaches for COVID-19: A Systematic Review and a Meta-analysis |
title_full | Evaluation of the Current Therapeutic Approaches for COVID-19: A Systematic Review and a Meta-analysis |
title_fullStr | Evaluation of the Current Therapeutic Approaches for COVID-19: A Systematic Review and a Meta-analysis |
title_full_unstemmed | Evaluation of the Current Therapeutic Approaches for COVID-19: A Systematic Review and a Meta-analysis |
title_short | Evaluation of the Current Therapeutic Approaches for COVID-19: A Systematic Review and a Meta-analysis |
title_sort | evaluation of the current therapeutic approaches for covid-19: a systematic review and a meta-analysis |
topic | Pharmacology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005525/ https://www.ncbi.nlm.nih.gov/pubmed/33790785 http://dx.doi.org/10.3389/fphar.2021.607408 |
work_keys_str_mv | AT abdelrahmanzeinab evaluationofthecurrenttherapeuticapproachesforcovid19asystematicreviewandametaanalysis AT liuqian evaluationofthecurrenttherapeuticapproachesforcovid19asystematicreviewandametaanalysis AT jiangshanmei evaluationofthecurrenttherapeuticapproachesforcovid19asystematicreviewandametaanalysis AT limengyuan evaluationofthecurrenttherapeuticapproachesforcovid19asystematicreviewandametaanalysis AT sunqingrong evaluationofthecurrenttherapeuticapproachesforcovid19asystematicreviewandametaanalysis AT zhangyue evaluationofthecurrenttherapeuticapproachesforcovid19asystematicreviewandametaanalysis AT wangxiaosheng evaluationofthecurrenttherapeuticapproachesforcovid19asystematicreviewandametaanalysis |