Perspectives on the Early Quality of Evidence Guiding the Therapeutic Management of SARS CoV-2: A Systematic Literature Review

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background:</jats:bold>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak is a serious health concern. Repurposing of existing drugs indicated for other conditions seems to be the first choice for immediate therapeutic management. The quality of early evidence favoring the different treatment options needs to be apprised for informed decision making. <jats:bold>Methods:</jats:bold>In this systematic literature review, we apprised the quality of available evidence for different therapeutic options and also the basis for different treatment guidelines. In order to include all studies that are in different stages of publications, we also included studies from the preprint servers, BioRxiv, MedRxiv and published studies from PubMed. <jats:bold>Results:</jats:bold>We retrieved 5621 articles and included 20 studies for the systematic review. Based on our study, chloroquine/hydroxychloroquine either alone or in combination with azithromycin, remdesivir, corticosteroids, convalescent sera, ritonavir/lopinavir and arbidol were evaluated as therapeutic options. The data from different study designs reveal contradictory findings except for convalescent sera for which the evidence available is only from case series. Based on these early evidence, various national guidelines recommend remdesivir, convalescent sera, corticosteroids, hydroxychloroquine in different sub set of patients. <jats:bold>Conclusion:</jats:bold>Establishing consensus with respect to the endpoints to be assessed for respiratory viruses may enhance the quality of evidences in case of future pandemics. Further clinical evidence from the ongoing trials may lead to evolution of treatment guidelines with the addition of more therapeutic options.</jats:p>

A complementary critical appraisal on systematic reviews regarding the most efficient therapeutic strategies for the current COVID‐19 (SARS‐CoV‐2) pandemic

“…No article from Science Direct fulfilled the inclusion criteria. After reading the full text of these articles, 22 articles formed the final sample (19 articles from Medline, 1 from Cochrane library, and 2 from other resources) 4,14,16‐35 . Inter‐rater agreement following the first round of screening between the two investigators was 93.90% (Cohen's k = 0.842).…”

“…Using corticosteroids was associated with virus clearance time, hospital length of stay, or duration of symptoms in a cohort study. They finally stated that these pieces of evidence provided ambiguous results due to their designs and the endpoints assessed 14 …”

“…Subramanian et al 14 evaluated the quality of early clinical evidence currently guiding the treatment strategies for COVID‐19 and the therapeutic recommendations of different treatment guidelines. They indicated that various national guidelines suggested remdesivir, convalescent sera, corticosteroids, and HCQ in different groups of patients.…”

“…A large number of studies have reported various treatments for MERS, SARS, and COVID‐19, whereas the major problem in this period of time is the lack of definite specific therapeutic drugs or vaccines for prevention. In spite of identifying various drug choices, scientific evidence is still incipient and of low methodological quality, and some previous systematic reviews and meta‐analysis claimed the poor quality of the included studies 4,14,15 …”

“…In spite of identifying various drug choices, scientific evidence is still incipient and of low methodological quality, and some previous systematic reviews and meta-analysis claimed the poor quality of the included studies. 4,14,15 Previous treatment strategies were explained and compared to find the most efficient drug regimen. The therapeutic protocols include supportive standard care, antivirals, antibiotics, vitamins, immunomodulators, antimalarial drugs, corticosteroids, antiretroviral drugs, convalescent plasma hemoperfusion, and extracorporeal membrane oxygenation (ECMO).…”