Comparative efficacy and safety of pharmacological interventions for severe COVID-19 patients: An updated network meta-analysis of 48 randomized controlled trials

Abstract

Background: To date, there has been little agreement on what drug is the "best" drug for treating severe COVID-19 patients. This study aimed to assess the efficacy and safety of different medications available at present for severe COVID-19. Methods: We searched databases for randomized controlled trials (RCTs) published up to February 28, 2022, with no language restrictions, of medications recommended for patients (aged 16 years or older) with severe COVID-19 infection. We extracted data on trials and patient characteristics, and the following primary outcomes: all-cause mortality (ACM), and treatment-emergent adverse events (TEAEs). Results: We identified 4021 abstracts and of these included 48 RCTs comprising 9147 participants through database searches and other sources. For decrease in ACM, we found that ivermectin/doxycycline, C-IVIG (i.e., a hyperimmune anti-COVID-19 intravenous immunoglobulin), methylprednisolone, interferon-beta/standard-of-care (SOC), interferon-beta-1b, convalescent plasma, remdesivir, lopinavir/ritonavir, immunoglobulin gamma, high dosage sarilumab (HS), auxora, and imatinib were effective when compared with placebo or SOC group. We found that colchicine and interferon-beta/SOC were only associated with the TEAEs of severe COVID-19 patients. Conclusion: This study suggested that ivermectin/doxycycline, C-IVIG, methylprednisolone, interferon-beta/SOC, interferon-beta-1b, convalescent plasma (CP), remdesivir, lopinavir/ritonavir, immunoglobulin gamma, HS, auxora, and imatinib were efficacious for treating severe COVID-19 patients. We found that most medications were safe in treating severe COVID-19. More large-scale RCTs are still needed to confirm the results of this study.

Does colchicine reduce mortality in patients with COVID-19 clinical syndrome? An umbrella review of published meta-analyses

“…Three studies [ [28] , [29] , [30] ] were excluded because of their qualitative design with no [ 31 ]pooled estimates of mortality outcomes. Zhang et al [ 31 ], and Cheng et al [ 24 ] were excluded based on their Bayesian network meta-analytical design. Although Han et al [ 32 ] did explore all range of therapeutic options in patients with severe acute respiratory syndrome (SARS), Middle East respiratory Syndrome (MERS), and COVID-19 since the onset of the pandemic, the review failed to provide a numerical point estimate of either efficacy or safety of colchicine exposure from their study.…”

“…Survival outcomes in COVID-19 patients exposed to it were discordant, with some studies reporting a decreased proportion of mortality, and others showing a null effect on survival [ [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] ]. In order to conclusively determine the exact relationship between colchicine exposure and mortality in these cohorts, several meta-analyses have been commissioned and published, unfortunately with residual uncertainty [ [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] ]. The latter is due to a subset of these reviews reporting increased survival with colchicine, while others were associated with no effect on mortality.…”

Does Colchicine Reduce Mortality in Patients with Covid-19 Clinical Syndrome? An Umbrella Review of Published Meta-Analyses

“…Its role in COVID-19 infection has particularly been highlighted in the early and late phases of the disease. Survival outcomes in COVID-19 patients exposed to it were discordant, with some studies reporting a decreased proportion of mortality, and others showing a null effect on survival [15][16][17][18][19][20][21][22][23][24][25]. In order to conclusively determine the exact relationship between colchicine exposure and mortality in these cohorts, several meta-analyses have been commissioned and published, unfortunately with residual uncertainty [15][16][17][18][19][20][21][22][23][24][25].…”

Dermatologie und Venerologie 2021–2022: Eine persönliche Sicht

“…Für Chloroquin ist diesbezüglich das letzte Wort noch nicht gesprochen; die (teilweise auch hochrangig publizierten) Studien sind widersprüchlich. Dagegen zeigte eine kürzlich veröffentlichte Metanalyse, dass die Kombination Ivermectin/Doxycyclin im Vergleich zu Placebo wirksam sein kann 6 …”