Rationale and prognosis of repurposed drugs with risk stratification of COVID-19 patients requiring Oxygen supplementation: A systematic review and meta-analysis

Abstract

Background The rising number of trials on repurposed dugs in COVID-19 has led to duplication and a need for curation of available outcomes from treatments that have been followed across the world. We have conducted a systematic review and meta-analysis that focus on evaluating the clinical outcomes of repurposed interventions against COVID-19. Methods Random effects model was adopted to estimate overall treatment effect and heterogeneity. Meta-regression was performed to study the correlation between comorbid conditions and non-invasive or invasive ventilation requirement. Results Twenty-nine articles met our eligibility criteria. In subgroup analysis, Tocilizumab was highly significant with lower mortality rate (OR 27.50; 95%CI [5.39-140.24]) of severe COVID-19 patients. Hydroxychloroquine and Lopinavir-ritonavir was found to be inefficacious in severe patients (OR 0.64; 95%CI [0.47-0.86] and 1.40 [0.71-2.76]). Dexamethasone had marginal effect on overall mortality rate (OR 1.19; 95%CI [1.05-1.35]). The meta-regression shows a positive correlation between prevalence of patients on Tocilizumab in non invasive support and hypertension condition (P = 0.02), whereas a negative correlation was identified with patients having lung disease (P = 0.03). Conclusion Overall, our study confirmed that tocilizumab may probably reduce the mortality rate (<10%) of severe COVID-19 patients than other interventions. Further, reduce the risk of requiring non-invasive ventilator support in patients with comorbid condition of lung disease. Hydroxychloroquine and Lopinavir-ritonavir has no clinical benefits in severe COVID-19. A high quality evidence is required to evaluate the usage of Serpin + Favipiravir combination in severe or critical COVID-19.

Efficacy of tocilizumab in the treatment of COVID‐19: An umbrella review

“… 19 After evaluating the other 92 articles for eligibility, 42 were excluded for the following reasons: one study investigated tocilizumab combined with another IL‐6 inhibitor, 20 two discussed therapies other than tocilizumab, 21 , 22 37 were not systematic reviews, 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 and two were systematic reviews of preclinical or animal studies. 60 , 61 Finally, 50 articles met the eligibility criteria and were included in the present umbrella review 6 , 28 , 62 , 63 , 64 , 65 , 66 …”

“…After evaluating the other 92 articles for eligibility, 42 were excluded for the following reasons: one study investigated tocilizumab combined with another IL‐6 inhibitor, 20 two discussed therapies other than tocilizumab, 21,22 37 were not systematic reviews, 23–59 and two were systematic reviews of preclinical or animal studies 60,61 . Finally, 50 articles met the eligibility criteria and were included in the present umbrella review 6,28,62–109 (Figure 1).…”