Repurposing of drugs for Covid-19: a systematic review and meta-analysis.
Identifieur interne : 000A06 ( Main/Corpus ); précédent : 000A05; suivant : 000A07Repurposing of drugs for Covid-19: a systematic review and meta-analysis.
Auteurs : Pinky Kotecha ; Alexander Light ; Enrico Checcucci ; Daniele Amparore ; Cristian Fiori ; Francesco Porpiglia ; Prokar Dasgupta ; Oussama ElhageSource :
- Panminerva medica [ 1827-1898 ] ; 2020.
Abstract
OBJECTIVE
The aim of this systematic review is to evaluate the data currently available regarding the repurposing of different drugs for Covid-19 treatment. Participants with suspected or diagnosed Covid-19 will be included. The interventions being considered are drugs being repurposed, and comparators will include standard of care treatment or placebo.
METHODS
We searched Ovid-MEDLINE, EMBASE, Cochrane library, clinical trial registration site in the UK(NIHR), Europe (clinicaltrialsregister.eu), US (ClinicalTrials.gov) and internationally (isrctn.com), and reviewed the reference lists of articles for eligible articles published up to April 22, 2020. All studies in English that evaluated the efficacy of the listed drugs were included. Cochrane RoB 2.0 and ROBINS-I tool were used to assess study quality. This systematic review adheres to the PRISMA guidelines. The protocol is available at PROSPERO (CRD42020180915).
RESULTS
From 708 identified studies or clinical trials, 16 studies and 16 case reports met our eligibility criteria. Of these, 6 were randomized controlled trials (763 patients), 7 cohort studies (321 patients) and 3 case series (191 patients). Chloroquine (CQ) had a 100% discharge rate compared to 50% with lopinavir-ritonavir at day 14, however a trial has recommended against a high dosage due to cardiotoxic events. Hydroxychloroquine (HCQ) has shown no significant improvement in negative seroconversion rate which is also seen in our meta-analysis (p=0.68). Adverse events with HCQ have a significant difference compared to the control group (p=0.001). Lopinavir-ritonavir has shown no improvement in time to clinical improvement which is seen in our meta-analyses (p=0.1). Remdesivir has shown no significant improvement in time to clinical improvement but this trial had insufficient power.
DISCUSSION
Due to the paucity in evidence, it is difficult to establish the efficacy of these drugs in the treatment of Covid-19 as currently there is no significant clinical effectiveness of the repurposed drugs. Further large clinical trials are required to achieve more reliable findings. A risk-benefit analysis is required on an individual basis to weigh out the potential improvement in clinical outcome and viral load reduction compared to the risks of the adverse events.
DOI: 10.23736/S0031-0808.20.04024-0
PubMed: 33073552
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pubmed:33073552Le document en format XML
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Prokar.dasgupta@kcl.ac.uk.</nlm:affiliation></affiliation></author><author><name sortKey="Elhage, Oussama" sort="Elhage, Oussama" uniqKey="Elhage O" first="Oussama" last="Elhage">Oussama Elhage</name><affiliation><nlm:affiliation>Faculty of Life Science & Medicine, King's College London, London, UK.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Panminerva medica</title><idno type="eISSN">1827-1898</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>OBJECTIVE</b></p><p>The aim of this systematic review is to evaluate the data currently available regarding the repurposing of different drugs for Covid-19 treatment. Participants with suspected or diagnosed Covid-19 will be included. The interventions being considered are drugs being repurposed, and comparators will include standard of care treatment or placebo.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>We searched Ovid-MEDLINE, EMBASE, Cochrane library, clinical trial registration site in the UK(NIHR), Europe (clinicaltrialsregister.eu), US (ClinicalTrials.gov) and internationally (isrctn.com), and reviewed the reference lists of articles for eligible articles published up to April 22, 2020. All studies in English that evaluated the efficacy of the listed drugs were included. Cochrane RoB 2.0 and ROBINS-I tool were used to assess study quality. This systematic review adheres to the PRISMA guidelines. The protocol is available at PROSPERO (CRD42020180915).</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>From 708 identified studies or clinical trials, 16 studies and 16 case reports met our eligibility criteria. Of these, 6 were randomized controlled trials (763 patients), 7 cohort studies (321 patients) and 3 case series (191 patients). Chloroquine (CQ) had a 100% discharge rate compared to 50% with lopinavir-ritonavir at day 14, however a trial has recommended against a high dosage due to cardiotoxic events. Hydroxychloroquine (HCQ) has shown no significant improvement in negative seroconversion rate which is also seen in our meta-analysis (p=0.68). Adverse events with HCQ have a significant difference compared to the control group (p=0.001). Lopinavir-ritonavir has shown no improvement in time to clinical improvement which is seen in our meta-analyses (p=0.1). Remdesivir has shown no significant improvement in time to clinical improvement but this trial had insufficient power.</p></div><div type="abstract" xml:lang="en"><p><b>DISCUSSION</b></p><p>Due to the paucity in evidence, it is difficult to establish the efficacy of these drugs in the treatment of Covid-19 as currently there is no significant clinical effectiveness of the repurposed drugs. Further large clinical trials are required to achieve more reliable findings. A risk-benefit analysis is required on an individual basis to weigh out the potential improvement in clinical outcome and viral load reduction compared to the risks of the adverse events.</p></div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">33073552</PMID><DateRevised><Year>2020</Year><Month>10</Month><Day>19</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1827-1898</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2020</Year><Month>Oct</Month><Day>19</Day></PubDate></JournalIssue><Title>Panminerva medica</Title><ISOAbbreviation>Panminerva Med</ISOAbbreviation></Journal><ArticleTitle>Repurposing of drugs for Covid-19: a systematic review and meta-analysis.</ArticleTitle><ELocationID EIdType="doi" ValidYN="Y">10.23736/S0031-0808.20.04024-0</ELocationID><Abstract><AbstractText Label="OBJECTIVE" NlmCategory="OBJECTIVE">The aim of this systematic review is to evaluate the data currently available regarding the repurposing of different drugs for Covid-19 treatment. Participants with suspected or diagnosed Covid-19 will be included. The interventions being considered are drugs being repurposed, and comparators will include standard of care treatment or placebo.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">We searched Ovid-MEDLINE, EMBASE, Cochrane library, clinical trial registration site in the UK(NIHR), Europe (clinicaltrialsregister.eu), US (ClinicalTrials.gov) and internationally (isrctn.com), and reviewed the reference lists of articles for eligible articles published up to April 22, 2020. All studies in English that evaluated the efficacy of the listed drugs were included. Cochrane RoB 2.0 and ROBINS-I tool were used to assess study quality. This systematic review adheres to the PRISMA guidelines. The protocol is available at PROSPERO (CRD42020180915).</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">From 708 identified studies or clinical trials, 16 studies and 16 case reports met our eligibility criteria. Of these, 6 were randomized controlled trials (763 patients), 7 cohort studies (321 patients) and 3 case series (191 patients). Chloroquine (CQ) had a 100% discharge rate compared to 50% with lopinavir-ritonavir at day 14, however a trial has recommended against a high dosage due to cardiotoxic events. Hydroxychloroquine (HCQ) has shown no significant improvement in negative seroconversion rate which is also seen in our meta-analysis (p=0.68). Adverse events with HCQ have a significant difference compared to the control group (p=0.001). Lopinavir-ritonavir has shown no improvement in time to clinical improvement which is seen in our meta-analyses (p=0.1). Remdesivir has shown no significant improvement in time to clinical improvement but this trial had insufficient power.</AbstractText><AbstractText Label="DISCUSSION" NlmCategory="CONCLUSIONS">Due to the paucity in evidence, it is difficult to establish the efficacy of these drugs in the treatment of Covid-19 as currently there is no significant clinical effectiveness of the repurposed drugs. Further large clinical trials are required to achieve more reliable findings. A risk-benefit analysis is required on an individual basis to weigh out the potential improvement in clinical outcome and viral load reduction compared to the risks of the adverse events.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Kotecha</LastName><ForeName>Pinky</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Faculty of Life Science & Medicine, King's College London, London, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Light</LastName><ForeName>Alexander</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Faculty of Life Science & Medicine, King's College London, London, UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Checcucci</LastName><ForeName>Enrico</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Amparore</LastName><ForeName>Daniele</ForeName><Initials>D</Initials><AffiliationInfo><Affiliation>Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Fiori</LastName><ForeName>Cristian</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Porpiglia</LastName><ForeName>Francesco</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Dasgupta</LastName><ForeName>Prokar</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Faculty of Life Science & Medicine, King's College London, London, UK - Prokar.dasgupta@kcl.ac.uk.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Elhage</LastName><ForeName>Oussama</ForeName><Initials>O</Initials><AffiliationInfo><Affiliation>Faculty of Life Science & Medicine, King's College London, London, UK.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>10</Month><Day>19</Day></ArticleDate></Article><MedlineJournalInfo><Country>Italy</Country><MedlineTA>Panminerva Med</MedlineTA><NlmUniqueID>0421110</NlmUniqueID><ISSNLinking>0031-0808</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>10</Month><Day>19</Day><Hour>6</Hour><Minute>24</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>10</Month><Day>20</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>10</Month><Day>20</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>aheadofprint</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">33073552</ArticleId><ArticleId IdType="pii">S0031-0808.20.04024-0</ArticleId><ArticleId IdType="doi">10.23736/S0031-0808.20.04024-0</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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