Evaluation of current medical approaches for COVID-19: a systematic review and meta-analysis

Abstract

BackgroundBecause of the lack of vaccination, it is urgent to find effective antiviral agents for COVID-19 treatment.MethodOnline databases were searched for articles published before or on 22 June 2020. Studies reporting the effectiveness and safety of antiviral agents for COVID-19 were analysed.ResultsA total of 42 studies were included in this analysis. Hydroxychloroquine (HCQ) was not associated with the incidence of death (risk ratio (RR)=1.08; 95% CI 0.81 to 1.44) and severe cases (RR=1.05; 95% CI 0.61 to 1.81). Patients treated with HCQ obtained few benefits with respect to the clearance of viral RNA and were more likely to have adverse reactions. HCQ treatment could shorten the body temperature recovery time (weighted mean difference = −1.04; 95% CI −1.64 to −0.45). Lopinavir/ritonavir (LPV/r) (RR=0.90; 95% CI 0.76 to 1.07) and Arbidol (RR=1.09; 95% CI 0.92 to 1.29) were not associated with the negative conversion rate. Integrative Chinese-Western medicine alleviated clinical symptoms and decreased the incidence of severe cases (RR=0.38; 95% CI 0.25 to 0.59). Remdesivir treatment reduced the 14-day mortality rate of patients with severe COVID-19 (RR=0.64; 95% CI 0.44 to 0.94). Convalescent plasma (CP) tended to increase the negative conversion rate (RR=2.47; 95% CI 1.70 to 3.57).ConclusionHCQ, LPV/r and Arbidol bring little benefit in COVID-19 treatment. Integrative Chinese-Western medicine improved the clinical symptoms of patients with COVID-19. Remdesivir and CP might be the potential treatments for patients with severe COVID-19. However, large-scale clinical randomised trials are needed to validate our conclusions.

Safety and Efficacy of Remdesivir for the Treatment of COVID-19: A Systematic Review and Meta-Analysis

“…The meta-analysis of the risk ratio suggests that remdesivir (in comparison with placebo/control) had no significant effects on mortality at day 14 of treatment in patients receiving the drug for 10 days. Our results are not in agreement with those systematic reviews recently reported (21,22). Wang et al pooled only two studies and found that remdesivir was significantly associated with a reduction in mortality at day 14 of treatment for patients with severe COVID-19 (RR= 0.64; 95% CI: 0.44-0.94) (21).…”

Treatment of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and coronavirus disease 2019 (COVID-19): a systematic review of in vitro, in vivo, and clinical trials

“…In the aforementioned RCT on COVID-19 comparing a combination of lopinavir/ritonavir and umifenovir with standard treatment 34 , and in another RCT on COVID-19 comparing “lopinavir/ritonavir plus IFN-α with or without ribavirin” with “ribavirin plus IFN-α” 41 , treatment with lopinavir/ritonavir did not show superior outcomes in terms of clinical deterioration or viral clearance ( Table 3 ). In meta-analyses on COVID-19 involving two of these RCTs 34 , 40 , treatment with lopinavir/ritonavir was not associated with clinical recovery or viral clearance 22 , 42 , 43 ( Table 4 ).…”

Therapeutic strategies to fight COVID-19: which is the status artis?

“…Moreover, no difference in efficacy was observed with lopinavir/ritonavir compared to umifenovir or hydroxychloroquine (Bhattacharyya et al, 2020). Another meta-analysis demonstrated no significant difference in terms of negative polymerase chain reaction (PCR) results between patients treated with lopinavir/ritonavir and those treated with the standard care (Wang et al, 2020a). Data from observational studies revealed no differences between lopinavir/ritonavir and hydroxychloroquine administered in patients with severe or mild-moderate COVID-19 (Choi et al, 2020;Karolyi et al, 2020;Lecronier et al, 2020).…”