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 reporting...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-03-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2021.607408/full |
| _version_ | 1818337205461975040 |
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| author | Zeinab Abdelrahman Zeinab Abdelrahman Qian Liu Qian Liu Shanmei Jiang Shanmei Jiang Mengyuan Li Mengyuan Li Qingrong Sun Qingrong Sun Yue Zhang Yue Zhang Yue Zhang Xiaosheng Wang Xiaosheng Wang |
| author_facet | Zeinab Abdelrahman Zeinab Abdelrahman Qian Liu Qian Liu Shanmei Jiang Shanmei Jiang Mengyuan Li Mengyuan Li Qingrong Sun Qingrong Sun Yue Zhang Yue Zhang Yue Zhang Xiaosheng Wang Xiaosheng Wang |
| author_sort | Zeinab Abdelrahman |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-12-13T14:51:31Z |
| format | Article |
| id | doaj.art-6b17e27684ea4d1c803e8a03fdb226ed |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-12-13T14:51:31Z |
| publishDate | 2021-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj.art-6b17e27684ea4d1c803e8a03fdb226ed2022-12-21T23:41:20ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122021-03-011210.3389/fphar.2021.607408607408Evaluation of the Current Therapeutic Approaches for COVID-19: A Systematic Review and a Meta-analysisZeinab Abdelrahman0Zeinab Abdelrahman1Qian Liu2Qian Liu3Shanmei Jiang4Shanmei Jiang5Mengyuan Li6Mengyuan Li7Qingrong Sun8Qingrong Sun9Yue Zhang10Yue Zhang11Yue Zhang12Xiaosheng Wang13Xiaosheng Wang14Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, ChinaBig Data Research Institute, China Pharmaceutical University, Nanjing, ChinaBiomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, ChinaBig Data Research Institute, China Pharmaceutical University, Nanjing, ChinaBiomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, ChinaBig Data Research Institute, China Pharmaceutical University, Nanjing, ChinaBiomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, ChinaBig Data Research Institute, China Pharmaceutical University, Nanjing, ChinaBiomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, ChinaBig Data Research Institute, China Pharmaceutical University, Nanjing, ChinaPinghu Hospital of Shenzhen University, Shenzhen, ChinaFutian Hospital for Rheumatic Diseases, Shenzhen, ChinaDepartment of Rheumatology and Immunology, The First Clinical College of Harbin Medical University, Harbin, ChinaBiomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, ChinaBig Data Research Institute, China Pharmaceutical University, Nanjing, ChinaBackground: 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.https://www.frontiersin.org/articles/10.3389/fphar.2021.607408/fullCOVID-19 treatmentmeta-analysisantiviral agentshydroxychloroquinedexamethasoneremdesivir |
| spellingShingle | Zeinab Abdelrahman Zeinab Abdelrahman Qian Liu Qian Liu Shanmei Jiang Shanmei Jiang Mengyuan Li Mengyuan Li Qingrong Sun Qingrong Sun Yue Zhang Yue Zhang Yue Zhang Xiaosheng Wang Xiaosheng Wang Evaluation of the Current Therapeutic Approaches for COVID-19: A Systematic Review and a Meta-analysis Frontiers in Pharmacology COVID-19 treatment meta-analysis antiviral agents hydroxychloroquine dexamethasone remdesivir |
| 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 | COVID-19 treatment meta-analysis antiviral agents hydroxychloroquine dexamethasone remdesivir |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2021.607408/full |
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