Coronavirus (1109) Comparative efficacy and safety of pharmacological interventions for the treatment of COVID-19: systematic review

13 January, 2021

Below are the citation, abstract and author summary of a systematic review in PLoS Medicine.

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

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

PLoS Medicine

Published: December 30, 2020 https://doi.org/10.1371/journal.pmed.1003501

ABSTRACT

Background: Numerous clinical trials and observational studies have investigated various pharmacological agents as potential treatment for Coronavirus Disease 2019 (COVID-19), but the results are heterogeneous and sometimes even contradictory to one another, making it difficult for clinicians to determine which treatments are truly effective.

Methods and findings: We carried out a systematic review and network meta-analysis (NMA) to systematically evaluate the comparative efficacy and safety of pharmacological interventions and the level of evidence behind each treatment regimen in different clinical settings [...]

Conclusions: In this NMA, we found that anti-inflammatory agents (corticosteroids, tocilizumab, anakinra, and IVIG), 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. Only 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.

AUTHOR SUMMARY

Why was the study done?

- Numerous clinical trials and observational studies have investigated various pharmacological agents as potential treatments for Coronavirus Disease 2019 (COVID-19), but systematic synthesis of this large body of information is not readily available.

- Results from these studies are heterogeneous and sometimes even contradictory to one another, making it difficult for clinicians to determine which treatments are truly effective.

- Level of evidence behind these drugs are diverse and must be classified into categories to effectively inform policy and practice.

What did the researchers do and find?

- In randomized controlled trials (RCTs), remdesivir and corticosteroid were shown to reduce COVID-19 aggravation and mortality rates.

- In the whole dataset, including data from RCTs and observational studies, anti-inflammatory agents (corticosteroid, tocilizumab, anakinra, and IVIG), convalescent plasma, and remdesivir were associated with improved clinical outcomes of COVID-19.

- Hydroxychloroquine provides no benefit in mitigating COVID-19 disease course while posing safety risks, especially to vulnerable populations.

What do these findings mean?

- These findings could help prioritize further research on drugs of possible benefit.

- Only 29% of current evidence on pharmacological management of COVID-19 is based on moderate/high evidence certainty and can be reflected in practice and policy; remaining 71% are of low or very low evidence certainty and warrant -further studies to establish firm conclusions.

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Best wishes, Neil

Coordinator, WHO-HIFA Collaboration: HIFA project on Essential Health Services and COVID-19

https://www.hifa.org/projects/essential-health-services-and-covid-19

Coordinator, HIFA project on COVID-19, supported by University of Edinburgh

https://www.hifa.org/projects/covid-19

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org