Current evidence for COVID-19 therapies: a systematic literature review.
Identifieur interne : 000225 ( Main/Corpus ); précédent : 000224; suivant : 000226Current evidence for COVID-19 therapies: a systematic literature review.
Auteurs : Tobias Welte ; Lucy J. Ambrose ; Gillian C. Sibbring ; Shehla Sheikh ; Hana Müllerová ; Ian SabirSource :
- European respiratory review : an official journal of the European Respiratory Society [ 1600-0617 ] ; 2021.
English descriptors
- KwdEn :
- Antiviral Agents (adverse effects), Antiviral Agents (therapeutic use), COVID-19 (diagnosis), COVID-19 (drug therapy), COVID-19 (mortality), COVID-19 (therapy), COVID-19 (virology), Clinical Trials as Topic (MeSH), Hospitalization (MeSH), Host-Pathogen Interactions (MeSH), Humans (MeSH), Immunization, Passive (MeSH), Respiration, Artificial (MeSH), SARS-CoV-2 (drug effects), SARS-CoV-2 (pathogenicity), Severity of Illness Index (MeSH), Treatment Outcome (MeSH).
- MESH :
- chemical , adverse effects : Antiviral Agents.
- chemical , therapeutic use : Antiviral Agents.
- diagnosis : COVID-19.
- drug effects : SARS-CoV-2.
- drug therapy : COVID-19.
- mortality : COVID-19.
- pathogenicity : SARS-CoV-2.
- therapy : COVID-19.
- virology : COVID-19.
- Clinical Trials as Topic, Hospitalization, Host-Pathogen Interactions, Humans, Immunization, Passive, Respiration, Artificial, Severity of Illness Index, Treatment Outcome.
Abstract
Effective therapeutic interventions for the treatment and prevention of coronavirus disease 2019 (COVID-19) are urgently needed. A systematic review was conducted to identify clinical trials of pharmacological interventions for COVID-19 published between 1 December 2019 and 14 October 2020. Data regarding efficacy of interventions, in terms of mortality, hospitalisation and need for ventilation, were extracted from identified studies and synthesised qualitatively. In total, 42 clinical trials were included. Interventions assessed included antiviral, mucolytic, antimalarial, anti-inflammatory and immunomodulatory therapies. Some reductions in mortality, hospitalisation and need for ventilation were seen with interferons and remdesivir, particularly when administered early, and with the mucolytic drug, bromhexine. Most studies of lopinavir/ritonavir and hydroxychloroquine did not show significant efficacy over standard care/placebo. Dexamethasone significantly reduced mortality, hospitalisation and need for ventilation versus standard care, particularly in patients with severe disease. Evidence for other classes of interventions was limited. Many trials had a moderate-to-high risk of bias, particularly in terms of blinding; most were short-term and some included low patient numbers.This review highlights the need for well-designed clinical trials of therapeutic interventions for COVID-19 to increase the quality of available evidence. It also emphasises the importance of tailoring interventions to disease stage and severity for maximum efficacy.
DOI: 10.1183/16000617.0384-2020
PubMed: 33731328
Links to Exploration step
pubmed:33731328Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Current evidence for COVID-19 therapies: a systematic literature review.</title><author><name sortKey="Welte, Tobias" sort="Welte, Tobias" uniqKey="Welte T" first="Tobias" last="Welte">Tobias Welte</name><affiliation><nlm:affiliation>Dept of Pulmonary and Infectious Diseases, Hannover University School of Medicine, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Ambrose, Lucy J" sort="Ambrose, Lucy J" uniqKey="Ambrose L" first="Lucy J" last="Ambrose">Lucy J. Ambrose</name><affiliation><nlm:affiliation>Prime Global, Oxford, UK.</nlm:affiliation></affiliation></author><author><name sortKey="Sibbring, Gillian C" sort="Sibbring, Gillian C" uniqKey="Sibbring G" first="Gillian C" last="Sibbring">Gillian C. Sibbring</name><affiliation><nlm:affiliation>Prime Global, Knutsford, UK.</nlm:affiliation></affiliation></author><author><name sortKey="Sheikh, Shehla" sort="Sheikh, Shehla" uniqKey="Sheikh S" first="Shehla" last="Sheikh">Shehla Sheikh</name><affiliation><nlm:affiliation>AstraZeneca, Cambridge, UK.</nlm:affiliation></affiliation></author><author><name sortKey="Mullerova, Hana" sort="Mullerova, Hana" uniqKey="Mullerova H" first="Hana" last="Müllerová">Hana Müllerová</name><affiliation><nlm:affiliation>AstraZeneca, Cambridge, UK.</nlm:affiliation></affiliation></author><author><name sortKey="Sabir, Ian" sort="Sabir, Ian" uniqKey="Sabir I" first="Ian" last="Sabir">Ian Sabir</name><affiliation><nlm:affiliation>AstraZeneca, Cambridge, UK.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2021">2021</date><idno type="RBID">pubmed:33731328</idno><idno type="pmid">33731328</idno><idno type="doi">10.1183/16000617.0384-2020</idno><idno type="wicri:Area/Main/Corpus">000225</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000225</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Current evidence for COVID-19 therapies: a systematic literature review.</title><author><name sortKey="Welte, Tobias" sort="Welte, Tobias" uniqKey="Welte T" first="Tobias" last="Welte">Tobias Welte</name><affiliation><nlm:affiliation>Dept of Pulmonary and Infectious Diseases, Hannover University School of Medicine, Germany.</nlm:affiliation></affiliation></author><author><name sortKey="Ambrose, Lucy J" sort="Ambrose, Lucy J" uniqKey="Ambrose L" first="Lucy J" last="Ambrose">Lucy J. Ambrose</name><affiliation><nlm:affiliation>Prime Global, Oxford, UK.</nlm:affiliation></affiliation></author><author><name sortKey="Sibbring, Gillian C" sort="Sibbring, Gillian C" uniqKey="Sibbring G" first="Gillian C" last="Sibbring">Gillian C. Sibbring</name><affiliation><nlm:affiliation>Prime Global, Knutsford, UK.</nlm:affiliation></affiliation></author><author><name sortKey="Sheikh, Shehla" sort="Sheikh, Shehla" uniqKey="Sheikh S" first="Shehla" last="Sheikh">Shehla Sheikh</name><affiliation><nlm:affiliation>AstraZeneca, Cambridge, UK.</nlm:affiliation></affiliation></author><author><name sortKey="Mullerova, Hana" sort="Mullerova, Hana" uniqKey="Mullerova H" first="Hana" last="Müllerová">Hana Müllerová</name><affiliation><nlm:affiliation>AstraZeneca, Cambridge, UK.</nlm:affiliation></affiliation></author><author><name sortKey="Sabir, Ian" sort="Sabir, Ian" uniqKey="Sabir I" first="Ian" last="Sabir">Ian Sabir</name><affiliation><nlm:affiliation>AstraZeneca, Cambridge, UK.</nlm:affiliation></affiliation></author></analytic><series><title level="j">European respiratory review : an official journal of the European Respiratory Society</title><idno type="eISSN">1600-0617</idno><imprint><date when="2021" type="published">2021</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antiviral Agents (adverse effects)</term><term>Antiviral Agents (therapeutic use)</term><term>COVID-19 (diagnosis)</term><term>COVID-19 (drug therapy)</term><term>COVID-19 (mortality)</term><term>COVID-19 (therapy)</term><term>COVID-19 (virology)</term><term>Clinical Trials as Topic (MeSH)</term><term>Hospitalization (MeSH)</term><term>Host-Pathogen Interactions (MeSH)</term><term>Humans (MeSH)</term><term>Immunization, Passive (MeSH)</term><term>Respiration, Artificial (MeSH)</term><term>SARS-CoV-2 (drug effects)</term><term>SARS-CoV-2 (pathogenicity)</term><term>Severity of Illness Index (MeSH)</term><term>Treatment Outcome (MeSH)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Antiviral Agents</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antiviral Agents</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>COVID-19</term></keywords><keywords scheme="MESH" qualifier="drug effects" xml:lang="en"><term>SARS-CoV-2</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>COVID-19</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>COVID-19</term></keywords><keywords scheme="MESH" qualifier="pathogenicity" xml:lang="en"><term>SARS-CoV-2</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>COVID-19</term></keywords><keywords scheme="MESH" qualifier="virology" xml:lang="en"><term>COVID-19</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Clinical Trials as Topic</term><term>Hospitalization</term><term>Host-Pathogen Interactions</term><term>Humans</term><term>Immunization, Passive</term><term>Respiration, Artificial</term><term>Severity of Illness Index</term><term>Treatment Outcome</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Effective therapeutic interventions for the treatment and prevention of coronavirus disease 2019 (COVID-19) are urgently needed. A systematic review was conducted to identify clinical trials of pharmacological interventions for COVID-19 published between 1 December 2019 and 14 October 2020. Data regarding efficacy of interventions, in terms of mortality, hospitalisation and need for ventilation, were extracted from identified studies and synthesised qualitatively. In total, 42 clinical trials were included. Interventions assessed included antiviral, mucolytic, antimalarial, anti-inflammatory and immunomodulatory therapies. Some reductions in mortality, hospitalisation and need for ventilation were seen with interferons and remdesivir, particularly when administered early, and with the mucolytic drug, bromhexine. Most studies of lopinavir/ritonavir and hydroxychloroquine did not show significant efficacy over standard care/placebo. Dexamethasone significantly reduced mortality, hospitalisation and need for ventilation <i>versus</i> standard care, particularly in patients with severe disease. Evidence for other classes of interventions was limited. Many trials had a moderate-to-high risk of bias, particularly in terms of blinding; most were short-term and some included low patient numbers.This review highlights the need for well-designed clinical trials of therapeutic interventions for COVID-19 to increase the quality of available evidence. It also emphasises the importance of tailoring interventions to disease stage and severity for maximum efficacy.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">33731328</PMID><DateCompleted><Year>2021</Year><Month>03</Month><Day>25</Day></DateCompleted><DateRevised><Year>2021</Year><Month>03</Month><Day>25</Day></DateRevised><Article PubModel="Electronic-Print"><Journal><ISSN IssnType="Electronic">1600-0617</ISSN><JournalIssue CitedMedium="Internet"><Volume>30</Volume><Issue>159</Issue><PubDate><Year>2021</Year><Month>Mar</Month><Day>31</Day></PubDate></JournalIssue><Title>European respiratory review : an official journal of the European Respiratory Society</Title><ISOAbbreviation>Eur Respir Rev</ISOAbbreviation></Journal><ArticleTitle>Current evidence for COVID-19 therapies: a systematic literature review.</ArticleTitle><ELocationID EIdType="pii" ValidYN="Y">200384</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1183/16000617.0384-2020</ELocationID><Abstract><AbstractText>Effective therapeutic interventions for the treatment and prevention of coronavirus disease 2019 (COVID-19) are urgently needed. A systematic review was conducted to identify clinical trials of pharmacological interventions for COVID-19 published between 1 December 2019 and 14 October 2020. Data regarding efficacy of interventions, in terms of mortality, hospitalisation and need for ventilation, were extracted from identified studies and synthesised qualitatively. In total, 42 clinical trials were included. Interventions assessed included antiviral, mucolytic, antimalarial, anti-inflammatory and immunomodulatory therapies. Some reductions in mortality, hospitalisation and need for ventilation were seen with interferons and remdesivir, particularly when administered early, and with the mucolytic drug, bromhexine. Most studies of lopinavir/ritonavir and hydroxychloroquine did not show significant efficacy over standard care/placebo. Dexamethasone significantly reduced mortality, hospitalisation and need for ventilation <i>versus</i> standard care, particularly in patients with severe disease. Evidence for other classes of interventions was limited. Many trials had a moderate-to-high risk of bias, particularly in terms of blinding; most were short-term and some included low patient numbers.This review highlights the need for well-designed clinical trials of therapeutic interventions for COVID-19 to increase the quality of available evidence. It also emphasises the importance of tailoring interventions to disease stage and severity for maximum efficacy.</AbstractText><CopyrightInformation>Copyright ©The authors 2021.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Welte</LastName><ForeName>Tobias</ForeName><Initials>T</Initials><Identifier Source="ORCID">https://orcid.org/0000-0002-9947-7356</Identifier><AffiliationInfo><Affiliation>Dept of Pulmonary and Infectious Diseases, Hannover University School of Medicine, Germany.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ambrose</LastName><ForeName>Lucy J</ForeName><Initials>LJ</Initials><AffiliationInfo><Affiliation>Prime Global, Oxford, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sibbring</LastName><ForeName>Gillian C</ForeName><Initials>GC</Initials><AffiliationInfo><Affiliation>Prime Global, Knutsford, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sheikh</LastName><ForeName>Shehla</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>AstraZeneca, Cambridge, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Müllerová</LastName><ForeName>Hana</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>AstraZeneca, Cambridge, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sabir</LastName><ForeName>Ian</ForeName><Initials>I</Initials><AffiliationInfo><Affiliation>AstraZeneca, Cambridge, UK.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D000078182">Systematic Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2021</Year><Month>03</Month><Day>17</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Eur Respir Rev</MedlineTA><NlmUniqueID>9111391</NlmUniqueID><ISSNLinking>0905-9180</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000998">Antiviral Agents</NameOfSubstance></Chemical></ChemicalList><SupplMeshList><SupplMeshName Type="Protocol" UI="C000705127">COVID-19 drug treatment</SupplMeshName><SupplMeshName Type="Protocol" UI="C000705128">COVID-19 serotherapy</SupplMeshName></SupplMeshList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000998" MajorTopicYN="N">Antiviral Agents</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000086382" MajorTopicYN="N">COVID-19</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="N">diagnosis</QualifierName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName><QualifierName UI="Q000401" MajorTopicYN="N">mortality</QualifierName><QualifierName UI="Q000628" MajorTopicYN="N">therapy</QualifierName><QualifierName UI="Q000821" MajorTopicYN="N">virology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002986" MajorTopicYN="N">Clinical Trials as Topic</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006760" MajorTopicYN="N">Hospitalization</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D054884" MajorTopicYN="N">Host-Pathogen Interactions</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007116" MajorTopicYN="N">Immunization, Passive</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012121" MajorTopicYN="N">Respiration, Artificial</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000086402" MajorTopicYN="N">SARS-CoV-2</DescriptorName><QualifierName UI="Q000187" MajorTopicYN="Y">drug effects</QualifierName><QualifierName UI="Q000472" MajorTopicYN="N">pathogenicity</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D012720" MajorTopicYN="N">Severity of Illness Index</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D016896" MajorTopicYN="N">Treatment Outcome</DescriptorName></MeshHeading></MeshHeadingList><CoiStatement>Conflict of interest: T. Welte reports personal fees, fees for lectures and consultancy fees from AstraZeneca, Basilea, Biotest, Bayer, Boehringer, GlaxoSmithKline, Janssens, Merck Sharp & Dohme, Novartis, Pfizer, Roche and Sanofi Aventis, outside the submitted work. Conflict of interest: L.J. Ambrose reports other funding from AstraZeneca, during the conduct of the study. Conflict of interest: G.C. Sibbring reports other funding from AstraZeneca, during the conduct of the study. Conflict of interest: S. Sheikh was an employee and shareholder of AstraZeneca at the time of manuscript preparation. Conflict of interest: H. Müllerová is an employee and shareholder of AstraZeneca. Conflict of interest: I. Sabir is an employee and shareholder of AstraZeneca.</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>12</Month><Day>04</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2021</Year><Month>02</Month><Day>10</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2021</Year><Month>3</Month><Day>18</Day><Hour>6</Hour><Minute>9</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2021</Year><Month>3</Month><Day>19</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2021</Year><Month>3</Month><Day>26</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>epublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">33731328</ArticleId><ArticleId IdType="pii">30/159/200384</ArticleId><ArticleId IdType="doi">10.1183/16000617.0384-2020</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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