tetano
Editor, Senior Moderator
Eur J Clin Invest
. 2020 Aug 18;e13383.
doi: 10.1111/eci.13383. Online ahead of print.
Efficacy of various treatment modalities for nCOV-2019: a systematic review and meta-analysis
Shubham Misra[SUP] 1 [/SUP], Manabesh Nath[SUP] 1 [/SUP], Vijay Hadda[SUP] 2 [/SUP], Deepti Vibha[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Several therapeutic agents have been investigated for treatment of novel Coronavirus-2019 (nCOV-2019). We conducted a systematic review and meta-analysis to assess the efficacy of various treatment modalities in nCOV-2019 patients.
Methods: A literature search was conducted before 29 June 2020 in PubMed, Google Scholar, Cochrane library databases. A fixed-effect model was applied if I[SUP]2[/SUP] <50%, else results were combined using random-effect model. Risk Ratio (RR) or Standardized Mean Difference (SMD) along-with 95% Confidence Interval (95%CI) were used to pool the results. Between-study heterogeneity was explored using influence and sensitivity analyses and publication bias was assessed using funnel plots. Entire statistical analysis was conducted in R version 3.6.2.
Results: Fifty studies involving 15 in-vitro and 35 clinical studies including 9170 nCOV-2019 patients were included. Lopinavir-Ritonavir was significantly associated with shorter mean time to clinical recovery (SMD -0.32; 95%CI -0.57 to -0.06), Remdesivir was significantly associated with better overall clinical recovery (RR 1.17; 95%CI 1.07 to 1.29) and Tocilizumab was associated with less all-cause mortality (RR 0.38; 95%CI 0.16 to 0.93). Hydroxychloroquine was associated with longer time to clinical recovery and less overall clinical recovery. It additionally had higher all-cause mortality and more total adverse events.
Conclusion: Our meta-analysis suggests that except in vitro studies, no treatment has shown overall favorable outcomes in nCOV-2019 patients. Lopinavir-Ritonavir, Remdesivir and Tocilizumab may have some benefits while Hydroxychloroquine administration may cause harm in nCOV-2019 patients. Results from upcoming large clinical trials may further clarify role of these drugs.
Keywords: Humans; Interventions; Novel Coronavirus-2019; Treatments; nCOV-2019.
. 2020 Aug 18;e13383.
doi: 10.1111/eci.13383. Online ahead of print.
Efficacy of various treatment modalities for nCOV-2019: a systematic review and meta-analysis
Shubham Misra[SUP] 1 [/SUP], Manabesh Nath[SUP] 1 [/SUP], Vijay Hadda[SUP] 2 [/SUP], Deepti Vibha[SUP] 1 [/SUP]
Affiliations
- PMID: 32810285
- DOI: 10.1111/eci.13383
Abstract
Background: Several therapeutic agents have been investigated for treatment of novel Coronavirus-2019 (nCOV-2019). We conducted a systematic review and meta-analysis to assess the efficacy of various treatment modalities in nCOV-2019 patients.
Methods: A literature search was conducted before 29 June 2020 in PubMed, Google Scholar, Cochrane library databases. A fixed-effect model was applied if I[SUP]2[/SUP] <50%, else results were combined using random-effect model. Risk Ratio (RR) or Standardized Mean Difference (SMD) along-with 95% Confidence Interval (95%CI) were used to pool the results. Between-study heterogeneity was explored using influence and sensitivity analyses and publication bias was assessed using funnel plots. Entire statistical analysis was conducted in R version 3.6.2.
Results: Fifty studies involving 15 in-vitro and 35 clinical studies including 9170 nCOV-2019 patients were included. Lopinavir-Ritonavir was significantly associated with shorter mean time to clinical recovery (SMD -0.32; 95%CI -0.57 to -0.06), Remdesivir was significantly associated with better overall clinical recovery (RR 1.17; 95%CI 1.07 to 1.29) and Tocilizumab was associated with less all-cause mortality (RR 0.38; 95%CI 0.16 to 0.93). Hydroxychloroquine was associated with longer time to clinical recovery and less overall clinical recovery. It additionally had higher all-cause mortality and more total adverse events.
Conclusion: Our meta-analysis suggests that except in vitro studies, no treatment has shown overall favorable outcomes in nCOV-2019 patients. Lopinavir-Ritonavir, Remdesivir and Tocilizumab may have some benefits while Hydroxychloroquine administration may cause harm in nCOV-2019 patients. Results from upcoming large clinical trials may further clarify role of these drugs.
Keywords: Humans; Interventions; Novel Coronavirus-2019; Treatments; nCOV-2019.