CovidChloroV1, Main, Corpus, bibRecord, 000080

Prophylaxis against covid-19: living systematic review and network meta-analysis.

Identifieur interne : 000080 ( Main/Corpus ); précédent : 000079; suivant : 000081

Prophylaxis against covid-19: living systematic review and network meta-analysis.

Auteurs : Jessica J. Bartoszko ; Reed A C. Siemieniuk ; Elena Kum ; Anila Qasim ; Dena Zeraatkar ; Long Ge ; Mi Ah Han ; Behnam Sadeghirad ; Arnav Agarwal ; Thomas Agoritsas ; Derek K. Chu ; Rachel Couban ; Andrea J. Darzi ; Tahira Devji ; Maryam Ghadimi ; Kimia Honarmand ; Ariel Izcovich ; Assem Khamis ; Francois Lamontagne ; Mark Loeb ; Maura Marcucci ; Shelley L. Mcleod ; Sharhzad Motaghi ; Srinivas Murthy ; Reem A. Mustafa ; John D. Neary ; Hector Pardo-Hernandez ; Gabriel Rada ; Bram Rochwerg ; Charlotte Switzer ; Britta Tendal ; Lehana Thabane ; Per O. Vandvik ; Robin W M. Vernooij ; Andrés Viteri-García ; Ying Wang ; Liang Yao ; Zhikang Ye ; Gordon H. Guyatt ; Romina Brignardello-Petersen

Source :

BMJ (Clinical research ed.) [ 1756-1833 ] ; 2021.

RBID : pubmed:33903131

English descriptors

KwdEn :
- Anti-Infective Agents (pharmacology), COVID-19 (prevention & control), Carrageenan (pharmacology), Chemoprevention (methods), Chemoprevention (statistics & numerical data), Global Health (statistics & numerical data), Humans (MeSH), Hydroxychloroquine (pharmacology), Ivermectin (pharmacology), SARS-CoV-2 (MeSH), Treatment Outcome (MeSH), Uncertainty (MeSH).
MESH :
- chemical , pharmacology : Anti-Infective Agents, Carrageenan, Hydroxychloroquine, Ivermectin.
- methods : Chemoprevention.
- prevention & control : COVID-19.
- statistics & numerical data : Chemoprevention, Global Health.
- Humans, SARS-CoV-2, Treatment Outcome, Uncertainty.

Abstract

OBJECTIVE

To determine and compare the effects of drug prophylaxis on SARS-CoV-2 infection and covid-19.

DESIGN

Living systematic review and network meta-analysis.

DATA SOURCES

World Health Organization covid-19 database, a comprehensive multilingual source of global covid-19 literature to 25 March 2021, and six additional Chinese databases to 20 February 2021.

STUDY SELECTION

Randomised trials of people at risk of covid-19 who were assigned to receive prophylaxis or no prophylaxis (standard care or placebo). Pairs of reviewers independently screened potentially eligible articles.

METHODS

Random effects bayesian network meta-analysis was performed after duplicate data abstraction. Included studies were assessed for risk of bias using a modification of the Cochrane risk of bias 2.0 tool, and certainty of evidence was assessed using the grading of recommendations assessment, development, and evaluation (GRADE) approach.

RESULTS

The first iteration of this living network meta-analysis includes nine randomised trials-six of hydroxychloroquine (n=6059 participants), one of ivermectin combined with iota-carrageenan (n=234), and two of ivermectin alone (n=540), all compared with standard care or placebo. Two trials (one of ramipril and one of bromhexine hydrochloride) did not meet the sample size requirements for network meta-analysis. Hydroxychloroquine has trivial to no effect on admission to hospital (risk difference 1 fewer per 1000 participants, 95% credible interval 3 fewer to 4 more; high certainty evidence) or mortality (1 fewer per 1000, 2 fewer to 3 more; high certainty). Hydroxychloroquine probably does not reduce the risk of laboratory confirmed SARS-CoV-2 infection (2 more per 1000, 18 fewer to 28 more; moderate certainty), probably increases adverse effects leading to drug discontinuation (19 more per 1000, 1 fewer to 70 more; moderate certainty), and may have trivial to no effect on suspected, probable, or laboratory confirmed SARS-CoV-2 infection (15 fewer per 1000, 64 fewer to 41 more; low certainty). Owing to serious risk of bias and very serious imprecision, and thus very low certainty of evidence, the effects of ivermectin combined with iota-carrageenan on laboratory confirmed covid-19 (52 fewer per 1000, 58 fewer to 37 fewer), ivermectin alone on laboratory confirmed infection (50 fewer per 1000, 59 fewer to 16 fewer) and suspected, probable, or laboratory confirmed infection (159 fewer per 1000, 165 fewer to 144 fewer) remain very uncertain.

CONCLUSIONS

Hydroxychloroquine prophylaxis has trivial to no effect on hospital admission and mortality, probably increases adverse effects, and probably does not reduce the risk of SARS-CoV-2 infection. Because of serious risk of bias and very serious imprecision, it is highly uncertain whether ivermectin combined with iota-carrageenan and ivermectin alone reduce the risk of SARS-CoV-2 infection.

SYSTEMATIC REVIEW REGISTRATION

This review was not registered. The protocol established a priori is included as a supplement.

READERS' NOTE

This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication.

DOI: 10.1136/bmj.n949
PubMed: 33903131
PubMed Central: PMC8073806

Links to Exploration step

pubmed:33903131

Le document en format XML

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<author><name sortKey="Bartoszko, Jessica J" sort="Bartoszko, Jessica J" uniqKey="Bartoszko J" first="Jessica J" last="Bartoszko">Jessica J. Bartoszko</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
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<affiliation><nlm:affiliation>Joint first authors.</nlm:affiliation>
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<author><name sortKey="Siemieniuk, Reed A C" sort="Siemieniuk, Reed A C" uniqKey="Siemieniuk R" first="Reed A C" last="Siemieniuk">Reed A C. Siemieniuk</name>
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<affiliation><nlm:affiliation>Joint first authors.</nlm:affiliation>
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<author><name sortKey="Kum, Elena" sort="Kum, Elena" uniqKey="Kum E" first="Elena" last="Kum">Elena Kum</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
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<affiliation><nlm:affiliation>Joint first authors.</nlm:affiliation>
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<author><name sortKey="Qasim, Anila" sort="Qasim, Anila" uniqKey="Qasim A" first="Anila" last="Qasim">Anila Qasim</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
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<affiliation><nlm:affiliation>Joint first authors.</nlm:affiliation>
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<author><name sortKey="Zeraatkar, Dena" sort="Zeraatkar, Dena" uniqKey="Zeraatkar D" first="Dena" last="Zeraatkar">Dena Zeraatkar</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
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<affiliation><nlm:affiliation>Joint first authors.</nlm:affiliation>
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<author><name sortKey="Ge, Long" sort="Ge, Long" uniqKey="Ge L" first="Long" last="Ge">Long Ge</name>
<affiliation><nlm:affiliation>Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China.</nlm:affiliation>
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<affiliation><nlm:affiliation>Joint first authors.</nlm:affiliation>
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<author><name sortKey="Han, Mi Ah" sort="Han, Mi Ah" uniqKey="Han M" first="Mi Ah" last="Han">Mi Ah Han</name>
<affiliation><nlm:affiliation>Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Sadeghirad, Behnam" sort="Sadeghirad, Behnam" uniqKey="Sadeghirad B" first="Behnam" last="Sadeghirad">Behnam Sadeghirad</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Department of Anesthesia, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Agarwal, Arnav" sort="Agarwal, Arnav" uniqKey="Agarwal A" first="Arnav" last="Agarwal">Arnav Agarwal</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Department of Medicine, University of Toronto, Toronto, ON, Canada.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Agoritsas, Thomas" sort="Agoritsas, Thomas" uniqKey="Agoritsas T" first="Thomas" last="Agoritsas">Thomas Agoritsas</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
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<affiliation><nlm:affiliation>Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland.</nlm:affiliation>
</affiliation>
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<author><name sortKey="Chu, Derek K" sort="Chu, Derek K" uniqKey="Chu D" first="Derek K" last="Chu">Derek K. Chu</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Department of Medicine, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Couban, Rachel" sort="Couban, Rachel" uniqKey="Couban R" first="Rachel" last="Couban">Rachel Couban</name>
<affiliation><nlm:affiliation>Department of Anesthesia, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Darzi, Andrea J" sort="Darzi, Andrea J" uniqKey="Darzi A" first="Andrea J" last="Darzi">Andrea J. Darzi</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Devji, Tahira" sort="Devji, Tahira" uniqKey="Devji T" first="Tahira" last="Devji">Tahira Devji</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Ghadimi, Maryam" sort="Ghadimi, Maryam" uniqKey="Ghadimi M" first="Maryam" last="Ghadimi">Maryam Ghadimi</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Honarmand, Kimia" sort="Honarmand, Kimia" uniqKey="Honarmand K" first="Kimia" last="Honarmand">Kimia Honarmand</name>
<affiliation><nlm:affiliation>Department of Medicine, Western University, London, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Izcovich, Ariel" sort="Izcovich, Ariel" uniqKey="Izcovich A" first="Ariel" last="Izcovich">Ariel Izcovich</name>
<affiliation><nlm:affiliation>Servicio de Clinica Médica del Hospital Alemán, Buenos Aires, Argentina.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Khamis, Assem" sort="Khamis, Assem" uniqKey="Khamis A" first="Assem" last="Khamis">Assem Khamis</name>
<affiliation><nlm:affiliation>Wolfson Palliative Care Research Centre, Hull York Medical School, York, UK.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Lamontagne, Francois" sort="Lamontagne, Francois" uniqKey="Lamontagne F" first="Francois" last="Lamontagne">Francois Lamontagne</name>
<affiliation><nlm:affiliation>Department of Medicine and Centre de recherche du CHU de Sherbrooke, Sherbrooke, QC, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Loeb, Mark" sort="Loeb, Mark" uniqKey="Loeb M" first="Mark" last="Loeb">Mark Loeb</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Department of Medicine, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Marcucci, Maura" sort="Marcucci, Maura" uniqKey="Marcucci M" first="Maura" last="Marcucci">Maura Marcucci</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Department of Medicine, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Mcleod, Shelley L" sort="Mcleod, Shelley L" uniqKey="Mcleod S" first="Shelley L" last="Mcleod">Shelley L. Mcleod</name>
<affiliation><nlm:affiliation>Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Motaghi, Sharhzad" sort="Motaghi, Sharhzad" uniqKey="Motaghi S" first="Sharhzad" last="Motaghi">Sharhzad Motaghi</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Murthy, Srinivas" sort="Murthy, Srinivas" uniqKey="Murthy S" first="Srinivas" last="Murthy">Srinivas Murthy</name>
<affiliation><nlm:affiliation>Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Mustafa, Reem A" sort="Mustafa, Reem A" uniqKey="Mustafa R" first="Reem A" last="Mustafa">Reem A. Mustafa</name>
<affiliation><nlm:affiliation>Department of Medicine, University of Kansas Medical Center, Kansas City, MO, USA.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Neary, John D" sort="Neary, John D" uniqKey="Neary J" first="John D" last="Neary">John D. Neary</name>
<affiliation><nlm:affiliation>Department of Medicine, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Pardo Hernandez, Hector" sort="Pardo Hernandez, Hector" uniqKey="Pardo Hernandez H" first="Hector" last="Pardo-Hernandez">Hector Pardo-Hernandez</name>
<affiliation><nlm:affiliation>Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Rada, Gabriel" sort="Rada, Gabriel" uniqKey="Rada G" first="Gabriel" last="Rada">Gabriel Rada</name>
<affiliation><nlm:affiliation>Epistemonikos Foundation, Santiago, Chile.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>C Evidence Center, Cochrane Chile Associated Center, Pontificia Universidad Católica de Chile, Santiago, Chile.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Rochwerg, Bram" sort="Rochwerg, Bram" uniqKey="Rochwerg B" first="Bram" last="Rochwerg">Bram Rochwerg</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Department of Medicine, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Switzer, Charlotte" sort="Switzer, Charlotte" uniqKey="Switzer C" first="Charlotte" last="Switzer">Charlotte Switzer</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Tendal, Britta" sort="Tendal, Britta" uniqKey="Tendal B" first="Britta" last="Tendal">Britta Tendal</name>
<affiliation><nlm:affiliation>School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Thabane, Lehana" sort="Thabane, Lehana" uniqKey="Thabane L" first="Lehana" last="Thabane">Lehana Thabane</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Vandvik, Per O" sort="Vandvik, Per O" uniqKey="Vandvik P" first="Per O" last="Vandvik">Per O. Vandvik</name>
<affiliation><nlm:affiliation>Institute of Health and Society, University of Oslo, Oslo, Norway.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Vernooij, Robin W M" sort="Vernooij, Robin W M" uniqKey="Vernooij R" first="Robin W M" last="Vernooij">Robin W M. Vernooij</name>
<affiliation><nlm:affiliation>Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Viteri Garcia, Andres" sort="Viteri Garcia, Andres" uniqKey="Viteri Garcia A" first="Andrés" last="Viteri-García">Andrés Viteri-García</name>
<affiliation><nlm:affiliation>Epistemonikos Foundation, Santiago, Chile.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Wang, Ying" sort="Wang, Ying" uniqKey="Wang Y" first="Ying" last="Wang">Ying Wang</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Yao, Liang" sort="Yao, Liang" uniqKey="Yao L" first="Liang" last="Yao">Liang Yao</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Ye, Zhikang" sort="Ye, Zhikang" uniqKey="Ye Z" first="Zhikang" last="Ye">Zhikang Ye</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Guyatt, Gordon H" sort="Guyatt, Gordon H" uniqKey="Guyatt G" first="Gordon H" last="Guyatt">Gordon H. Guyatt</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Department of Medicine, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Brignardello Petersen, Romina" sort="Brignardello Petersen, Romina" uniqKey="Brignardello Petersen R" first="Romina" last="Brignardello-Petersen">Romina Brignardello-Petersen</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
</titleStmt>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">Prophylaxis against covid-19: living systematic review and network meta-analysis.</title>
<author><name sortKey="Bartoszko, Jessica J" sort="Bartoszko, Jessica J" uniqKey="Bartoszko J" first="Jessica J" last="Bartoszko">Jessica J. Bartoszko</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Joint first authors.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Siemieniuk, Reed A C" sort="Siemieniuk, Reed A C" uniqKey="Siemieniuk R" first="Reed A C" last="Siemieniuk">Reed A C. Siemieniuk</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada reed.siemieniuk@medportal.ca.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Joint first authors.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Kum, Elena" sort="Kum, Elena" uniqKey="Kum E" first="Elena" last="Kum">Elena Kum</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Joint first authors.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Qasim, Anila" sort="Qasim, Anila" uniqKey="Qasim A" first="Anila" last="Qasim">Anila Qasim</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Joint first authors.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Zeraatkar, Dena" sort="Zeraatkar, Dena" uniqKey="Zeraatkar D" first="Dena" last="Zeraatkar">Dena Zeraatkar</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Joint first authors.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Ge, Long" sort="Ge, Long" uniqKey="Ge L" first="Long" last="Ge">Long Ge</name>
<affiliation><nlm:affiliation>Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Joint first authors.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Han, Mi Ah" sort="Han, Mi Ah" uniqKey="Han M" first="Mi Ah" last="Han">Mi Ah Han</name>
<affiliation><nlm:affiliation>Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Sadeghirad, Behnam" sort="Sadeghirad, Behnam" uniqKey="Sadeghirad B" first="Behnam" last="Sadeghirad">Behnam Sadeghirad</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Department of Anesthesia, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Agarwal, Arnav" sort="Agarwal, Arnav" uniqKey="Agarwal A" first="Arnav" last="Agarwal">Arnav Agarwal</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Department of Medicine, University of Toronto, Toronto, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Agoritsas, Thomas" sort="Agoritsas, Thomas" uniqKey="Agoritsas T" first="Thomas" last="Agoritsas">Thomas Agoritsas</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Chu, Derek K" sort="Chu, Derek K" uniqKey="Chu D" first="Derek K" last="Chu">Derek K. Chu</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Department of Medicine, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Couban, Rachel" sort="Couban, Rachel" uniqKey="Couban R" first="Rachel" last="Couban">Rachel Couban</name>
<affiliation><nlm:affiliation>Department of Anesthesia, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Darzi, Andrea J" sort="Darzi, Andrea J" uniqKey="Darzi A" first="Andrea J" last="Darzi">Andrea J. Darzi</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Devji, Tahira" sort="Devji, Tahira" uniqKey="Devji T" first="Tahira" last="Devji">Tahira Devji</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Ghadimi, Maryam" sort="Ghadimi, Maryam" uniqKey="Ghadimi M" first="Maryam" last="Ghadimi">Maryam Ghadimi</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Honarmand, Kimia" sort="Honarmand, Kimia" uniqKey="Honarmand K" first="Kimia" last="Honarmand">Kimia Honarmand</name>
<affiliation><nlm:affiliation>Department of Medicine, Western University, London, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Izcovich, Ariel" sort="Izcovich, Ariel" uniqKey="Izcovich A" first="Ariel" last="Izcovich">Ariel Izcovich</name>
<affiliation><nlm:affiliation>Servicio de Clinica Médica del Hospital Alemán, Buenos Aires, Argentina.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Khamis, Assem" sort="Khamis, Assem" uniqKey="Khamis A" first="Assem" last="Khamis">Assem Khamis</name>
<affiliation><nlm:affiliation>Wolfson Palliative Care Research Centre, Hull York Medical School, York, UK.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Lamontagne, Francois" sort="Lamontagne, Francois" uniqKey="Lamontagne F" first="Francois" last="Lamontagne">Francois Lamontagne</name>
<affiliation><nlm:affiliation>Department of Medicine and Centre de recherche du CHU de Sherbrooke, Sherbrooke, QC, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Loeb, Mark" sort="Loeb, Mark" uniqKey="Loeb M" first="Mark" last="Loeb">Mark Loeb</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Department of Medicine, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Marcucci, Maura" sort="Marcucci, Maura" uniqKey="Marcucci M" first="Maura" last="Marcucci">Maura Marcucci</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Department of Medicine, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Mcleod, Shelley L" sort="Mcleod, Shelley L" uniqKey="Mcleod S" first="Shelley L" last="Mcleod">Shelley L. Mcleod</name>
<affiliation><nlm:affiliation>Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Motaghi, Sharhzad" sort="Motaghi, Sharhzad" uniqKey="Motaghi S" first="Sharhzad" last="Motaghi">Sharhzad Motaghi</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Murthy, Srinivas" sort="Murthy, Srinivas" uniqKey="Murthy S" first="Srinivas" last="Murthy">Srinivas Murthy</name>
<affiliation><nlm:affiliation>Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Mustafa, Reem A" sort="Mustafa, Reem A" uniqKey="Mustafa R" first="Reem A" last="Mustafa">Reem A. Mustafa</name>
<affiliation><nlm:affiliation>Department of Medicine, University of Kansas Medical Center, Kansas City, MO, USA.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Neary, John D" sort="Neary, John D" uniqKey="Neary J" first="John D" last="Neary">John D. Neary</name>
<affiliation><nlm:affiliation>Department of Medicine, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Pardo Hernandez, Hector" sort="Pardo Hernandez, Hector" uniqKey="Pardo Hernandez H" first="Hector" last="Pardo-Hernandez">Hector Pardo-Hernandez</name>
<affiliation><nlm:affiliation>Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Rada, Gabriel" sort="Rada, Gabriel" uniqKey="Rada G" first="Gabriel" last="Rada">Gabriel Rada</name>
<affiliation><nlm:affiliation>Epistemonikos Foundation, Santiago, Chile.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>C Evidence Center, Cochrane Chile Associated Center, Pontificia Universidad Católica de Chile, Santiago, Chile.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Rochwerg, Bram" sort="Rochwerg, Bram" uniqKey="Rochwerg B" first="Bram" last="Rochwerg">Bram Rochwerg</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Department of Medicine, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Switzer, Charlotte" sort="Switzer, Charlotte" uniqKey="Switzer C" first="Charlotte" last="Switzer">Charlotte Switzer</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Tendal, Britta" sort="Tendal, Britta" uniqKey="Tendal B" first="Britta" last="Tendal">Britta Tendal</name>
<affiliation><nlm:affiliation>School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Thabane, Lehana" sort="Thabane, Lehana" uniqKey="Thabane L" first="Lehana" last="Thabane">Lehana Thabane</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Vandvik, Per O" sort="Vandvik, Per O" uniqKey="Vandvik P" first="Per O" last="Vandvik">Per O. Vandvik</name>
<affiliation><nlm:affiliation>Institute of Health and Society, University of Oslo, Oslo, Norway.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Vernooij, Robin W M" sort="Vernooij, Robin W M" uniqKey="Vernooij R" first="Robin W M" last="Vernooij">Robin W M. Vernooij</name>
<affiliation><nlm:affiliation>Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Viteri Garcia, Andres" sort="Viteri Garcia, Andres" uniqKey="Viteri Garcia A" first="Andrés" last="Viteri-García">Andrés Viteri-García</name>
<affiliation><nlm:affiliation>Epistemonikos Foundation, Santiago, Chile.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Wang, Ying" sort="Wang, Ying" uniqKey="Wang Y" first="Ying" last="Wang">Ying Wang</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Yao, Liang" sort="Yao, Liang" uniqKey="Yao L" first="Liang" last="Yao">Liang Yao</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Ye, Zhikang" sort="Ye, Zhikang" uniqKey="Ye Z" first="Zhikang" last="Ye">Zhikang Ye</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Guyatt, Gordon H" sort="Guyatt, Gordon H" uniqKey="Guyatt G" first="Gordon H" last="Guyatt">Gordon H. Guyatt</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
<affiliation><nlm:affiliation>Department of Medicine, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Brignardello Petersen, Romina" sort="Brignardello Petersen, Romina" uniqKey="Brignardello Petersen R" first="Romina" last="Brignardello-Petersen">Romina Brignardello-Petersen</name>
<affiliation><nlm:affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</nlm:affiliation>
</affiliation>
</author>
</analytic>
<series><title level="j">BMJ (Clinical research ed.)</title>
<idno type="eISSN">1756-1833</idno>
<imprint><date when="2021" type="published">2021</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Anti-Infective Agents (pharmacology)</term>
<term>COVID-19 (prevention & control)</term>
<term>Carrageenan (pharmacology)</term>
<term>Chemoprevention (methods)</term>
<term>Chemoprevention (statistics & numerical data)</term>
<term>Global Health (statistics & numerical data)</term>
<term>Humans (MeSH)</term>
<term>Hydroxychloroquine (pharmacology)</term>
<term>Ivermectin (pharmacology)</term>
<term>SARS-CoV-2 (MeSH)</term>
<term>Treatment Outcome (MeSH)</term>
<term>Uncertainty (MeSH)</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="pharmacology" xml:lang="en"><term>Anti-Infective Agents</term>
<term>Carrageenan</term>
<term>Hydroxychloroquine</term>
<term>Ivermectin</term>
</keywords>
<keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Chemoprevention</term>
</keywords>
<keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>COVID-19</term>
</keywords>
<keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Chemoprevention</term>
<term>Global Health</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Humans</term>
<term>SARS-CoV-2</term>
<term>Treatment Outcome</term>
<term>Uncertainty</term>
</keywords>
</textClass>
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</teiHeader>
<front><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b>
</p>
<p>To determine and compare the effects of drug prophylaxis on SARS-CoV-2 infection and covid-19.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>DESIGN</b>
</p>
<p>Living systematic review and network meta-analysis.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>DATA SOURCES</b>
</p>
<p>World Health Organization covid-19 database, a comprehensive multilingual source of global covid-19 literature to 25 March 2021, and six additional Chinese databases to 20 February 2021.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>STUDY SELECTION</b>
</p>
<p>Randomised trials of people at risk of covid-19 who were assigned to receive prophylaxis or no prophylaxis (standard care or placebo). Pairs of reviewers independently screened potentially eligible articles.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHODS</b>
</p>
<p>Random effects bayesian network meta-analysis was performed after duplicate data abstraction. Included studies were assessed for risk of bias using a modification of the Cochrane risk of bias 2.0 tool, and certainty of evidence was assessed using the grading of recommendations assessment, development, and evaluation (GRADE) approach.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>The first iteration of this living network meta-analysis includes nine randomised trials-six of hydroxychloroquine (n=6059 participants), one of ivermectin combined with iota-carrageenan (n=234), and two of ivermectin alone (n=540), all compared with standard care or placebo. Two trials (one of ramipril and one of bromhexine hydrochloride) did not meet the sample size requirements for network meta-analysis. Hydroxychloroquine has trivial to no effect on admission to hospital (risk difference 1 fewer per 1000 participants, 95% credible interval 3 fewer to 4 more; high certainty evidence) or mortality (1 fewer per 1000, 2 fewer to 3 more; high certainty). Hydroxychloroquine probably does not reduce the risk of laboratory confirmed SARS-CoV-2 infection (2 more per 1000, 18 fewer to 28 more; moderate certainty), probably increases adverse effects leading to drug discontinuation (19 more per 1000, 1 fewer to 70 more; moderate certainty), and may have trivial to no effect on suspected, probable, or laboratory confirmed SARS-CoV-2 infection (15 fewer per 1000, 64 fewer to 41 more; low certainty). Owing to serious risk of bias and very serious imprecision, and thus very low certainty of evidence, the effects of ivermectin combined with iota-carrageenan on laboratory confirmed covid-19 (52 fewer per 1000, 58 fewer to 37 fewer), ivermectin alone on laboratory confirmed infection (50 fewer per 1000, 59 fewer to 16 fewer) and suspected, probable, or laboratory confirmed infection (159 fewer per 1000, 165 fewer to 144 fewer) remain very uncertain.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b>
</p>
<p>Hydroxychloroquine prophylaxis has trivial to no effect on hospital admission and mortality, probably increases adverse effects, and probably does not reduce the risk of SARS-CoV-2 infection. Because of serious risk of bias and very serious imprecision, it is highly uncertain whether ivermectin combined with iota-carrageenan and ivermectin alone reduce the risk of SARS-CoV-2 infection.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>SYSTEMATIC REVIEW REGISTRATION</b>
</p>
<p>This review was not registered. The protocol established a priori is included as a supplement.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>READERS' NOTE</b>
</p>
<p>This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication.</p>
</div>
</front>
</TEI>
<pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">33903131</PMID>
<DateCompleted><Year>2021</Year>
<Month>05</Month>
<Day>03</Day>
</DateCompleted>
<DateRevised><Year>2021</Year>
<Month>05</Month>
<Day>03</Day>
</DateRevised>
<Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">1756-1833</ISSN>
<JournalIssue CitedMedium="Internet"><Volume>373</Volume>
<PubDate><Year>2021</Year>
<Month>04</Month>
<Day>26</Day>
</PubDate>
</JournalIssue>
<Title>BMJ (Clinical research ed.)</Title>
<ISOAbbreviation>BMJ</ISOAbbreviation>
</Journal>
<ArticleTitle>Prophylaxis against covid-19: living systematic review and network meta-analysis.</ArticleTitle>
<Pagination><MedlinePgn>n949</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1136/bmj.n949</ELocationID>
<Abstract><AbstractText Label="OBJECTIVE">To determine and compare the effects of drug prophylaxis on SARS-CoV-2 infection and covid-19.</AbstractText>
<AbstractText Label="DESIGN">Living systematic review and network meta-analysis.</AbstractText>
<AbstractText Label="DATA SOURCES">World Health Organization covid-19 database, a comprehensive multilingual source of global covid-19 literature to 25 March 2021, and six additional Chinese databases to 20 February 2021.</AbstractText>
<AbstractText Label="STUDY SELECTION">Randomised trials of people at risk of covid-19 who were assigned to receive prophylaxis or no prophylaxis (standard care or placebo). Pairs of reviewers independently screened potentially eligible articles.</AbstractText>
<AbstractText Label="METHODS">Random effects bayesian network meta-analysis was performed after duplicate data abstraction. Included studies were assessed for risk of bias using a modification of the Cochrane risk of bias 2.0 tool, and certainty of evidence was assessed using the grading of recommendations assessment, development, and evaluation (GRADE) approach.</AbstractText>
<AbstractText Label="RESULTS">The first iteration of this living network meta-analysis includes nine randomised trials-six of hydroxychloroquine (n=6059 participants), one of ivermectin combined with iota-carrageenan (n=234), and two of ivermectin alone (n=540), all compared with standard care or placebo. Two trials (one of ramipril and one of bromhexine hydrochloride) did not meet the sample size requirements for network meta-analysis. Hydroxychloroquine has trivial to no effect on admission to hospital (risk difference 1 fewer per 1000 participants, 95% credible interval 3 fewer to 4 more; high certainty evidence) or mortality (1 fewer per 1000, 2 fewer to 3 more; high certainty). Hydroxychloroquine probably does not reduce the risk of laboratory confirmed SARS-CoV-2 infection (2 more per 1000, 18 fewer to 28 more; moderate certainty), probably increases adverse effects leading to drug discontinuation (19 more per 1000, 1 fewer to 70 more; moderate certainty), and may have trivial to no effect on suspected, probable, or laboratory confirmed SARS-CoV-2 infection (15 fewer per 1000, 64 fewer to 41 more; low certainty). Owing to serious risk of bias and very serious imprecision, and thus very low certainty of evidence, the effects of ivermectin combined with iota-carrageenan on laboratory confirmed covid-19 (52 fewer per 1000, 58 fewer to 37 fewer), ivermectin alone on laboratory confirmed infection (50 fewer per 1000, 59 fewer to 16 fewer) and suspected, probable, or laboratory confirmed infection (159 fewer per 1000, 165 fewer to 144 fewer) remain very uncertain.</AbstractText>
<AbstractText Label="CONCLUSIONS">Hydroxychloroquine prophylaxis has trivial to no effect on hospital admission and mortality, probably increases adverse effects, and probably does not reduce the risk of SARS-CoV-2 infection. Because of serious risk of bias and very serious imprecision, it is highly uncertain whether ivermectin combined with iota-carrageenan and ivermectin alone reduce the risk of SARS-CoV-2 infection.</AbstractText>
<AbstractText Label="SYSTEMATIC REVIEW REGISTRATION">This review was not registered. The protocol established a priori is included as a supplement.</AbstractText>
<AbstractText Label="READERS' NOTE">This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication.</AbstractText>
<CopyrightInformation>© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</CopyrightInformation>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Bartoszko</LastName>
<ForeName>Jessica J</ForeName>
<Initials>JJ</Initials>
<AffiliationInfo><Affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Joint first authors.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Siemieniuk</LastName>
<ForeName>Reed A C</ForeName>
<Initials>RAC</Initials>
<Identifier Source="ORCID">0000-0002-3725-3031</Identifier>
<AffiliationInfo><Affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada reed.siemieniuk@medportal.ca.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Joint first authors.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Kum</LastName>
<ForeName>Elena</ForeName>
<Initials>E</Initials>
<AffiliationInfo><Affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Joint first authors.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Qasim</LastName>
<ForeName>Anila</ForeName>
<Initials>A</Initials>
<AffiliationInfo><Affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Joint first authors.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Zeraatkar</LastName>
<ForeName>Dena</ForeName>
<Initials>D</Initials>
<AffiliationInfo><Affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Joint first authors.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Ge</LastName>
<ForeName>Long</ForeName>
<Initials>L</Initials>
<AffiliationInfo><Affiliation>Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Joint first authors.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Han</LastName>
<ForeName>Mi Ah</ForeName>
<Initials>MA</Initials>
<AffiliationInfo><Affiliation>Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Sadeghirad</LastName>
<ForeName>Behnam</ForeName>
<Initials>B</Initials>
<AffiliationInfo><Affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Department of Anesthesia, McMaster University, Hamilton, ON, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Agarwal</LastName>
<ForeName>Arnav</ForeName>
<Initials>A</Initials>
<AffiliationInfo><Affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Department of Medicine, University of Toronto, Toronto, ON, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Agoritsas</LastName>
<ForeName>Thomas</ForeName>
<Initials>T</Initials>
<AffiliationInfo><Affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Chu</LastName>
<ForeName>Derek K</ForeName>
<Initials>DK</Initials>
<AffiliationInfo><Affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Department of Medicine, McMaster University, Hamilton, ON, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Couban</LastName>
<ForeName>Rachel</ForeName>
<Initials>R</Initials>
<AffiliationInfo><Affiliation>Department of Anesthesia, McMaster University, Hamilton, ON, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Darzi</LastName>
<ForeName>Andrea J</ForeName>
<Initials>AJ</Initials>
<AffiliationInfo><Affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Devji</LastName>
<ForeName>Tahira</ForeName>
<Initials>T</Initials>
<AffiliationInfo><Affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Ghadimi</LastName>
<ForeName>Maryam</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Honarmand</LastName>
<ForeName>Kimia</ForeName>
<Initials>K</Initials>
<AffiliationInfo><Affiliation>Department of Medicine, Western University, London, ON, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Izcovich</LastName>
<ForeName>Ariel</ForeName>
<Initials>A</Initials>
<AffiliationInfo><Affiliation>Servicio de Clinica Médica del Hospital Alemán, Buenos Aires, Argentina.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Khamis</LastName>
<ForeName>Assem</ForeName>
<Initials>A</Initials>
<AffiliationInfo><Affiliation>Wolfson Palliative Care Research Centre, Hull York Medical School, York, UK.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Lamontagne</LastName>
<ForeName>Francois</ForeName>
<Initials>F</Initials>
<AffiliationInfo><Affiliation>Department of Medicine and Centre de recherche du CHU de Sherbrooke, Sherbrooke, QC, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Loeb</LastName>
<ForeName>Mark</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Department of Medicine, McMaster University, Hamilton, ON, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Marcucci</LastName>
<ForeName>Maura</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Department of Medicine, McMaster University, Hamilton, ON, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>McLeod</LastName>
<ForeName>Shelley L</ForeName>
<Initials>SL</Initials>
<AffiliationInfo><Affiliation>Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada.</Affiliation>
</AffiliationInfo>
<AffiliationInfo><Affiliation>Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.</Affiliation>
</AffiliationInfo>
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<CoiStatement>Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: BS reports receiving funding from PIPRA AG (www.pipra.ch) to conduct a systematic review and individual patient data meta-analysis on predictors of postoperative delirium in elderly people in 2020-21; funding from Mitacs Canada, Accelerate internship in partnership with Nestlé Canada to support his graduate student stipend from 2016 to 2018. Mitacs is a national, not-for-profit organisation that has designed and delivered research and training programmes in Canada, working with universities, companies, and both federal and provincial governments; and funding from the International Life Sciences Institute (ILSI)-North America to support his graduate work for his 2015 academic year. In 2016-17, BS worked part-time for the Cornerstone Research Group (CRG), a contract research organisation. The ILSI funding and being employed by CRG are outside the required three year period requested on the ICJME form. ML reports personal fees and non-financial support from Sanofi, grants and personal fees from Seqirus, and personal fees from Pfizer and Medicago outside the submitted work; and is co-investigator on an Anti-Coronavirus Therapies (ACT) randomised trial of covid-19 treatment. LG reports grants from the Ministry of Science and Technology of China, outside the submitted work. All other authors report no financial relationships with any organisations that might have an interest in the submitted work in the previous three years and no other relationships or activities that could appear to have influenced the submitted work.</CoiStatement>
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Prophylaxis against covid-19: living systematic review and network meta-analysis.

Prophylaxis against covid-19: living systematic review and network meta-analysis.

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