Evaluating the Efficacy and Safety of the Existing Repurposed Pharmacological Agents for Treating COVID-19: A Meta-analysis and Systematic Review of Clinical Trials.
Identifieur interne : 000570 ( Main/Corpus ); précédent : 000569; suivant : 000571Evaluating the Efficacy and Safety of the Existing Repurposed Pharmacological Agents for Treating COVID-19: A Meta-analysis and Systematic Review of Clinical Trials.
Auteurs : Nang S. Choupoo ; Saurabh K. Das ; Rudrashish Haldar ; Hillol Sarkar ; Resma Tewari ; Sumit RaySource :
- Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine [ 0972-5229 ] ; 2020.
Abstract
Purpose
The present study systematically searched important medical databases, assessed the quality of available pieces of evidence, and performed a meta-analysis to test the efficacy of different therapeutic options currently available for treating COVID-19.
Materials and methods
PubMed, CNKI, LILACS, Koreamed, WHO clinical trial registry, and medRxiv were searched since December 2019. Any observational or controlled study that tested the efficacy of any pharmacological intervention in COVID-19 patients either prospectively or retrospectively was included in the qualitative analysis. We assessed outcomes as dichotomous variables, i.e., a patient having a positive clinical outcome. Relative risks/risk ratios (RR) having a 95% confidence interval (CI) were derived. Studies conforming to inclusion criteria were pooled using the random-effect model.
Results
Nine trials on hydroxychloroquine (HCQ), six studies on antiviral, four studies on monoclonal antibodies, two on corticosteroids, two on convalescent plasma (CP), and one on interferon-α2b were included in the systematic review. Meta-analysis containing six scientific trials and analyzing 522 patients revealed that the relative risk of positive clinical outcomes with HCQ treatment was 1.042 (95% CI, 0.884 to 1.874) with a number needed to treat (NNT) of 12.6. A meta-analysis of two studies analyzing 285 patients showed that the relative risk of clinical resolution with lopinavir and ritonavir combination was 1.152 (95% CI 0.709 to 1.87). Out of various antiviral used, the only remdesivir showed a positive result in a case series. Monoclonal antibodies showed decreased C-reactive protein, decreased oxygen, and ventilator requirements. A corticosteroid may increase mortality with increased dose. Two small case series on CP showed some promising results.
Conclusion
The study showed slightly favorable results with HCQ, monoclonal antibodies, remdesivir, and CP in treating COVID-19 patients. Further research is warranted in establishing the efficacy of studied interventions.
PROSPERO identifier
CRD42020180979.
How to cite this article
Choupoo NS, Das SK, Haldar R, Sarkar H, Tewari R, Ray S. Evaluating the Efficacy and Safety of the Existing Repurposed Pharmacological Agents for Treating COVID-19: A Meta-analysis and Systematic Review of Clinical Trials. Indian J Crit Care Med 2020;24(11):1106-1113.
DOI: 10.5005/jp-journals-10071-23664
PubMed: 33384519
PubMed Central: PMC7751050
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pubmed:33384519Le document en format XML
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Das</name><affiliation><nlm:affiliation>Department of Critical Care, Artemis Hospital, Gurugram, Haryana, India.</nlm:affiliation></affiliation></author><author><name sortKey="Haldar, Rudrashish" sort="Haldar, Rudrashish" uniqKey="Haldar R" first="Rudrashish" last="Haldar">Rudrashish Haldar</name><affiliation><nlm:affiliation>Department of Anesthesia, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.</nlm:affiliation></affiliation></author><author><name sortKey="Sarkar, Hillol" sort="Sarkar, Hillol" uniqKey="Sarkar H" first="Hillol" last="Sarkar">Hillol Sarkar</name><affiliation><nlm:affiliation>Department of Medicine, Fakhruddin Ali Ahmed Medical College and Hospital, Joti Gaon, Assam, India.</nlm:affiliation></affiliation></author><author><name sortKey="Tewari, Resma" sort="Tewari, Resma" uniqKey="Tewari R" first="Resma" last="Tewari">Resma Tewari</name><affiliation><nlm:affiliation>Department of Critical Care, Artemis Hospital, Gurugram, Haryana, India.</nlm:affiliation></affiliation></author><author><name sortKey="Ray, Sumit" sort="Ray, Sumit" uniqKey="Ray S" first="Sumit" last="Ray">Sumit Ray</name><affiliation><nlm:affiliation>Department of Critical Care, Medical Services, Artemis Hospital, Gurugram, Haryana, India.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2020">2020</date><idno type="RBID">pubmed:33384519</idno><idno type="pmid">33384519</idno><idno type="doi">10.5005/jp-journals-10071-23664</idno><idno type="pmc">PMC7751050</idno><idno type="wicri:Area/Main/Corpus">000570</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000570</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Evaluating the Efficacy and Safety of the Existing Repurposed Pharmacological Agents for Treating COVID-19: A Meta-analysis and Systematic Review of Clinical Trials.</title><author><name sortKey="Choupoo, Nang S" sort="Choupoo, Nang S" uniqKey="Choupoo N" first="Nang S" last="Choupoo">Nang S. Choupoo</name><affiliation><nlm:affiliation>Department of Anesthesia and Critical Care, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India.</nlm:affiliation></affiliation></author><author><name sortKey="Das, Saurabh K" sort="Das, Saurabh K" uniqKey="Das S" first="Saurabh K" last="Das">Saurabh K. Das</name><affiliation><nlm:affiliation>Department of Critical Care, Artemis Hospital, Gurugram, Haryana, India.</nlm:affiliation></affiliation></author><author><name sortKey="Haldar, Rudrashish" sort="Haldar, Rudrashish" uniqKey="Haldar R" first="Rudrashish" last="Haldar">Rudrashish Haldar</name><affiliation><nlm:affiliation>Department of Anesthesia, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.</nlm:affiliation></affiliation></author><author><name sortKey="Sarkar, Hillol" sort="Sarkar, Hillol" uniqKey="Sarkar H" first="Hillol" last="Sarkar">Hillol Sarkar</name><affiliation><nlm:affiliation>Department of Medicine, Fakhruddin Ali Ahmed Medical College and Hospital, Joti Gaon, Assam, India.</nlm:affiliation></affiliation></author><author><name sortKey="Tewari, Resma" sort="Tewari, Resma" uniqKey="Tewari R" first="Resma" last="Tewari">Resma Tewari</name><affiliation><nlm:affiliation>Department of Critical Care, Artemis Hospital, Gurugram, Haryana, India.</nlm:affiliation></affiliation></author><author><name sortKey="Ray, Sumit" sort="Ray, Sumit" uniqKey="Ray S" first="Sumit" last="Ray">Sumit Ray</name><affiliation><nlm:affiliation>Department of Critical Care, Medical Services, Artemis Hospital, Gurugram, Haryana, India.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine</title><idno type="ISSN">0972-5229</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>Purpose</b></p><p>The present study systematically searched important medical databases, assessed the quality of available pieces of evidence, and performed a meta-analysis to test the efficacy of different therapeutic options currently available for treating COVID-19.</p></div><div type="abstract" xml:lang="en"><p><b>Materials and methods</b></p><p>PubMed, CNKI, LILACS, Koreamed, WHO clinical trial registry, and medRxiv were searched since December 2019. Any observational or controlled study that tested the efficacy of any pharmacological intervention in COVID-19 patients either prospectively or retrospectively was included in the qualitative analysis. We assessed outcomes as dichotomous variables, i.e., a patient having a positive clinical outcome. Relative risks/risk ratios (RR) having a 95% confidence interval (CI) were derived. Studies conforming to inclusion criteria were pooled using the random-effect model.</p></div><div type="abstract" xml:lang="en"><p><b>Results</b></p><p>Nine trials on hydroxychloroquine (HCQ), six studies on antiviral, four studies on monoclonal antibodies, two on corticosteroids, two on convalescent plasma (CP), and one on interferon-α2b were included in the systematic review. Meta-analysis containing six scientific trials and analyzing 522 patients revealed that the relative risk of positive clinical outcomes with HCQ treatment was 1.042 (95% CI, 0.884 to 1.874) with a number needed to treat (NNT) of 12.6. A meta-analysis of two studies analyzing 285 patients showed that the relative risk of clinical resolution with lopinavir and ritonavir combination was 1.152 (95% CI 0.709 to 1.87). Out of various antiviral used, the only remdesivir showed a positive result in a case series. Monoclonal antibodies showed decreased C-reactive protein, decreased oxygen, and ventilator requirements. A corticosteroid may increase mortality with increased dose. Two small case series on CP showed some promising results.</p></div><div type="abstract" xml:lang="en"><p><b>Conclusion</b></p><p>The study showed slightly favorable results with HCQ, monoclonal antibodies, remdesivir, and CP in treating COVID-19 patients. Further research is warranted in establishing the efficacy of studied interventions.</p></div><div type="abstract" xml:lang="en"><p><b>PROSPERO identifier</b></p><p>CRD42020180979.</p></div><div type="abstract" xml:lang="en"><p><b>How to cite this article</b></p><p>Choupoo NS, Das SK, Haldar R, Sarkar H, Tewari R, Ray S. Evaluating the Efficacy and Safety of the Existing Repurposed Pharmacological Agents for Treating COVID-19: A Meta-analysis and Systematic Review of Clinical Trials. Indian J Crit Care Med 2020;24(11):1106-1113.</p></div></front></TEI><pubmed><MedlineCitation Status="PubMed-not-MEDLINE" Owner="NLM"><PMID Version="1">33384519</PMID><DateRevised><Year>2021</Year><Month>01</Month><Day>02</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Print">0972-5229</ISSN><JournalIssue CitedMedium="Print"><Volume>24</Volume><Issue>11</Issue><PubDate><Year>2020</Year><Month>Nov</Month></PubDate></JournalIssue><Title>Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine</Title><ISOAbbreviation>Indian J Crit Care Med</ISOAbbreviation></Journal><ArticleTitle>Evaluating the Efficacy and Safety of the Existing Repurposed Pharmacological Agents for Treating COVID-19: A Meta-analysis and Systematic Review of Clinical Trials.</ArticleTitle><Pagination><MedlinePgn>1106-1113</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.5005/jp-journals-10071-23664</ELocationID><Abstract><AbstractText Label="Purpose" NlmCategory="UNASSIGNED">The present study systematically searched important medical databases, assessed the quality of available pieces of evidence, and performed a meta-analysis to test the efficacy of different therapeutic options currently available for treating COVID-19.</AbstractText><AbstractText Label="Materials and methods" NlmCategory="UNASSIGNED">PubMed, CNKI, LILACS, Koreamed, WHO clinical trial registry, and medRxiv were searched since December 2019. Any observational or controlled study that tested the efficacy of any pharmacological intervention in COVID-19 patients either prospectively or retrospectively was included in the qualitative analysis. We assessed outcomes as dichotomous variables, i.e., a patient having a positive clinical outcome. Relative risks/risk ratios (RR) having a 95% confidence interval (CI) were derived. Studies conforming to inclusion criteria were pooled using the random-effect model.</AbstractText><AbstractText Label="Results" NlmCategory="UNASSIGNED">Nine trials on hydroxychloroquine (HCQ), six studies on antiviral, four studies on monoclonal antibodies, two on corticosteroids, two on convalescent plasma (CP), and one on interferon-α2b were included in the systematic review. Meta-analysis containing six scientific trials and analyzing 522 patients revealed that the relative risk of positive clinical outcomes with HCQ treatment was 1.042 (95% CI, 0.884 to 1.874) with a number needed to treat (NNT) of 12.6. A meta-analysis of two studies analyzing 285 patients showed that the relative risk of clinical resolution with lopinavir and ritonavir combination was 1.152 (95% CI 0.709 to 1.87). Out of various antiviral used, the only remdesivir showed a positive result in a case series. Monoclonal antibodies showed decreased C-reactive protein, decreased oxygen, and ventilator requirements. A corticosteroid may increase mortality with increased dose. Two small case series on CP showed some promising results.</AbstractText><AbstractText Label="Conclusion" NlmCategory="UNASSIGNED">The study showed slightly favorable results with HCQ, monoclonal antibodies, remdesivir, and CP in treating COVID-19 patients. Further research is warranted in establishing the efficacy of studied interventions.</AbstractText><AbstractText Label="PROSPERO identifier" NlmCategory="UNASSIGNED">CRD42020180979.</AbstractText><AbstractText Label="How to cite this article" NlmCategory="UNASSIGNED">Choupoo NS, Das SK, Haldar R, Sarkar H, Tewari R, Ray S. Evaluating the Efficacy and Safety of the Existing Repurposed Pharmacological Agents for Treating COVID-19: A Meta-analysis and Systematic Review of Clinical Trials. Indian J Crit Care Med 2020;24(11):1106-1113.</AbstractText><CopyrightInformation>Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Choupoo</LastName><ForeName>Nang S</ForeName><Initials>NS</Initials><AffiliationInfo><Affiliation>Department of Anesthesia and Critical Care, Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML Hospital, New Delhi, India.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Das</LastName><ForeName>Saurabh K</ForeName><Initials>SK</Initials><AffiliationInfo><Affiliation>Department of Critical Care, Artemis Hospital, Gurugram, Haryana, India.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Haldar</LastName><ForeName>Rudrashish</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Department of Anesthesia, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sarkar</LastName><ForeName>Hillol</ForeName><Initials>H</Initials><AffiliationInfo><Affiliation>Department of Medicine, Fakhruddin Ali Ahmed Medical College and Hospital, Joti Gaon, Assam, India.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Tewari</LastName><ForeName>Resma</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>Department of Critical Care, Artemis Hospital, Gurugram, Haryana, India.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ray</LastName><ForeName>Sumit</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Critical Care, Medical Services, Artemis Hospital, Gurugram, Haryana, India.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>India</Country><MedlineTA>Indian J Crit Care Med</MedlineTA><NlmUniqueID>101208863</NlmUniqueID><ISSNLinking>0972-5229</ISSNLinking></MedlineJournalInfo><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">COVID-19</Keyword><Keyword MajorTopicYN="N">Chloroquine</Keyword><Keyword MajorTopicYN="N">Convalescent plasma</Keyword><Keyword MajorTopicYN="N">Coronavirus</Keyword><Keyword MajorTopicYN="N">Hydroxychloroquine</Keyword><Keyword MajorTopicYN="N">Lopinavir</Keyword><Keyword MajorTopicYN="N">Ritonavir</Keyword><Keyword MajorTopicYN="N">SARS-CoV-2</Keyword></KeywordList><CoiStatement>Source of support: Nil Conflict of interest: None</CoiStatement></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2021</Year><Month>1</Month><Day>1</Day><Hour>5</Hour><Minute>21</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2021</Year><Month>1</Month><Day>2</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2021</Year><Month>1</Month><Day>2</Day><Hour>6</Hour><Minute>1</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">33384519</ArticleId><ArticleId IdType="doi">10.5005/jp-journals-10071-23664</ArticleId><ArticleId IdType="pmc">PMC7751050</ArticleId></ArticleIdList><ReferenceList><Reference><Citation>N Engl J Med. 2020 May 7;382(19):1787-1799</Citation><ArticleIdList><ArticleId IdType="pubmed">32187464</ArticleId></ArticleIdList></Reference><Reference><Citation>J Antimicrob Chemother. 2020 Jul 1;75(7):1667-1670</Citation><ArticleIdList><ArticleId IdType="pubmed">32196083</ArticleId></ArticleIdList></Reference><Reference><Citation>Int J Antimicrob Agents. 2020 May;55(5):105938</Citation><ArticleIdList><ArticleId IdType="pubmed">32171740</ArticleId></ArticleIdList></Reference><Reference><Citation>Travel Med Infect Dis. 2020 Mar - 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