Repurposed drug studies on the primary prevention of SARS-CoV-2 infection during the pandemic: systematic review and meta-analysis
Objective Current evidence on the effectiveness of SARS-CoV-2 prophylaxis is inconclusive. We aimed to systematically evaluate published studies on repurposed drugs for the prevention of laboratory-confirmed SARS-CoV-2 infection and/or COVID-19 among healthy adults.Design Systematic review.Eligibili...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-11-01
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| Series: | BMJ Open Respiratory Research |
| Online Access: | https://bmjopenrespres.bmj.com/content/10/1/e001674.full |
| _version_ | 1797371260990128128 |
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| author | Judith M Vonk Eelko Hak Katrien Oude Rengerink Hubert G M Niesters Debbie van Baarle Maarten J Bijlsma Guiling Zhou Stefan Verweij Stijn de Vos Anna Maria Gerdina Pasmooij Peter Mol |
| author_facet | Judith M Vonk Eelko Hak Katrien Oude Rengerink Hubert G M Niesters Debbie van Baarle Maarten J Bijlsma Guiling Zhou Stefan Verweij Stijn de Vos Anna Maria Gerdina Pasmooij Peter Mol |
| author_sort | Judith M Vonk |
| collection | DOAJ |
| description | Objective Current evidence on the effectiveness of SARS-CoV-2 prophylaxis is inconclusive. We aimed to systematically evaluate published studies on repurposed drugs for the prevention of laboratory-confirmed SARS-CoV-2 infection and/or COVID-19 among healthy adults.Design Systematic review.Eligibility Quantitative experimental and observational intervention studies that evaluated the effectiveness of repurposed drugs for the primary prevention of SARS-CoV-2 infection and/or COVID-19 disease.Data source PubMed and Embase (1 January 2020–28 September 2022).Risk of bias Cochrane Risk of Bias 2.0 and Risk of Bias in Non-Randomised Studies of Interventions tools were applied to assess the quality of studies.Data analysis Meta-analyses for each eligible drug were performed if ≥2 similar study designs were available.Results In all, 65 (25 trials, 40 observational) and 29 publications were eligible for review and meta-analyses, respectively. Most studies pertained to hydroxychloroquine (32), ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) (11), statin (8), and ivermectin (8). In trials, hydroxychloroquine prophylaxis reduced laboratory-confirmed SARS-CoV-2 infection (risk ratio: 0.82 (95% CI 0.74 to 0.90), I2=48%), a result largely driven by one clinical trial (weight: 60.5%). Such beneficial effects were not observed in observational studies, nor for prognostic clinical outcomes. Ivermectin did not significantly reduce the risk of SARS-CoV-2 infection (RR: 0.35 (95% CI 0.10 to 1.26), I2=96%) and findings for clinical outcomes were inconsistent. Neither ACEi or ARB were beneficial in reducing SARS-CoV-2 infection. Most of the evidence from clinical trials was of moderate quality and of lower quality in observational studies.Conclusions Results from our analysis are insufficient to support an evidence-based repurposed drug policy for SARS-CoV-2 prophylaxis because of inconsistency. In the view of scarce supportive evidence on repurposing drugs for COVID-19, alternative strategies such as immunisation of vulnerable people are warranted to prevent the future waves of infection.PROSPERO registration number CRD42021292797. |
| first_indexed | 2024-03-08T18:17:20Z |
| format | Article |
| id | doaj.art-21cd98ae02b5486ea9d64750c16b16f3 |
| institution | Directory Open Access Journal |
| issn | 2052-4439 |
| language | English |
| last_indexed | 2024-03-08T18:17:20Z |
| publishDate | 2023-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Respiratory Research |
| spelling | doaj.art-21cd98ae02b5486ea9d64750c16b16f32023-12-31T07:55:07ZengBMJ Publishing GroupBMJ Open Respiratory Research2052-44392023-11-0110110.1136/bmjresp-2023-001674Repurposed drug studies on the primary prevention of SARS-CoV-2 infection during the pandemic: systematic review and meta-analysisJudith M Vonk0Eelko Hak1Katrien Oude Rengerink2Hubert G M Niesters3Debbie van Baarle4Maarten J Bijlsma5Guiling Zhou6Stefan Verweij7Stijn de Vos8Anna Maria Gerdina Pasmooij9Peter Mol103 Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The NetherlandsUnit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The NetherlandsDutch Medicines Evaluation Board, Utrecht, The NetherlandsDepartment of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, Groningen, The NetherlandsVirology and Immunology Research Group, Department of Medical Microbiology and Infection Prevention, University Medical Centre, Groningen, The NetherlandsUnit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The NetherlandsUnit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The NetherlandsUnit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The NetherlandsUnit of PharmacoTherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The NetherlandsDutch Medicines Evaluation Board, Utrecht, The NetherlandsDutch Medicines Evaluation Board, Utrecht, The NetherlandsObjective Current evidence on the effectiveness of SARS-CoV-2 prophylaxis is inconclusive. We aimed to systematically evaluate published studies on repurposed drugs for the prevention of laboratory-confirmed SARS-CoV-2 infection and/or COVID-19 among healthy adults.Design Systematic review.Eligibility Quantitative experimental and observational intervention studies that evaluated the effectiveness of repurposed drugs for the primary prevention of SARS-CoV-2 infection and/or COVID-19 disease.Data source PubMed and Embase (1 January 2020–28 September 2022).Risk of bias Cochrane Risk of Bias 2.0 and Risk of Bias in Non-Randomised Studies of Interventions tools were applied to assess the quality of studies.Data analysis Meta-analyses for each eligible drug were performed if ≥2 similar study designs were available.Results In all, 65 (25 trials, 40 observational) and 29 publications were eligible for review and meta-analyses, respectively. Most studies pertained to hydroxychloroquine (32), ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) (11), statin (8), and ivermectin (8). In trials, hydroxychloroquine prophylaxis reduced laboratory-confirmed SARS-CoV-2 infection (risk ratio: 0.82 (95% CI 0.74 to 0.90), I2=48%), a result largely driven by one clinical trial (weight: 60.5%). Such beneficial effects were not observed in observational studies, nor for prognostic clinical outcomes. Ivermectin did not significantly reduce the risk of SARS-CoV-2 infection (RR: 0.35 (95% CI 0.10 to 1.26), I2=96%) and findings for clinical outcomes were inconsistent. Neither ACEi or ARB were beneficial in reducing SARS-CoV-2 infection. Most of the evidence from clinical trials was of moderate quality and of lower quality in observational studies.Conclusions Results from our analysis are insufficient to support an evidence-based repurposed drug policy for SARS-CoV-2 prophylaxis because of inconsistency. In the view of scarce supportive evidence on repurposing drugs for COVID-19, alternative strategies such as immunisation of vulnerable people are warranted to prevent the future waves of infection.PROSPERO registration number CRD42021292797.https://bmjopenrespres.bmj.com/content/10/1/e001674.full |
| spellingShingle | Judith M Vonk Eelko Hak Katrien Oude Rengerink Hubert G M Niesters Debbie van Baarle Maarten J Bijlsma Guiling Zhou Stefan Verweij Stijn de Vos Anna Maria Gerdina Pasmooij Peter Mol Repurposed drug studies on the primary prevention of SARS-CoV-2 infection during the pandemic: systematic review and meta-analysis BMJ Open Respiratory Research |
| title | Repurposed drug studies on the primary prevention of SARS-CoV-2 infection during the pandemic: systematic review and meta-analysis |
| title_full | Repurposed drug studies on the primary prevention of SARS-CoV-2 infection during the pandemic: systematic review and meta-analysis |
| title_fullStr | Repurposed drug studies on the primary prevention of SARS-CoV-2 infection during the pandemic: systematic review and meta-analysis |
| title_full_unstemmed | Repurposed drug studies on the primary prevention of SARS-CoV-2 infection during the pandemic: systematic review and meta-analysis |
| title_short | Repurposed drug studies on the primary prevention of SARS-CoV-2 infection during the pandemic: systematic review and meta-analysis |
| title_sort | repurposed drug studies on the primary prevention of sars cov 2 infection during the pandemic systematic review and meta analysis |
| url | https://bmjopenrespres.bmj.com/content/10/1/e001674.full |
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