Zhong, Han
Wang, Yan
Zhang, Zai-Li
Liu, Yang-Xi
Le, Ke-Jia
Cu, Min
Yu, Yue-Tian
Gu, Zhi-Chun
Gao, Yuan
Lin, Hou-Wen
2020-08-11T14:33:13Z
2020-08-11T14:33:13Z
2020
1043-6618
https://doi.org/10.1016/j.phrs.2020.104872
http://hdl.handle.net/20.500.12010/11826
The rapidly progressing of coronavirus disease 2019 (COVID-19) pandemic has become a global concern. This
meta-analysis aimed at evaluating the efficacy and safety of current option of therapies for severe acute respiratory syndrome (SARS), Middle Eastern respiratory syndrome (MERS) besides COVID-19, in an attempt to
identify promising therapy for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients.
We searched PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), China
Science and Technology Journal Database (VIP), and WANFANG DATA for randomized controlled trials (RCTs),
prospective cohort, and retrospective cohort studies that evaluated therapies (hydroxychloroquine, lopinavir/
ritonavir-based therapy, and ribavirin-based therapy, etc.) for SARS, MERS, and COVID-19. The primary outcomes were mortality, virological eradication and clinical improvement, and secondary outcomes were improvement of symptoms and chest radiography results, incidence of acute respiratory disease syndrome (ARDS),
utilization of mechanical ventilation, and adverse events (AEs). Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random-effects models, and the quality of evidence was appraised
using GRADEpro.
Eighteen articles (5 RCTs, 2 prospective cohort studies, and 11 retrospective cohort studies) involving 4,941
patients were included. Compared with control treatment, anti-coronary virus interventions significantly reduced mortality (RR 0.65, 95% CI 0.44-0.96; I
2 = 81.3%), remarkably ameliorate clinical improvement (RR
1.52, 95% CI 1.05-2.19) and radiographical improvement (RR 1.62, 95% CI 1.11-2.36, I 2 = 11.0 %), without
manifesting clear effect on virological eradication, incidence of ARDS, intubation, and AEs. Subgroup analyses
demonstrated that the combination of ribavirin and corticosteroids remarkably decreased mortality (RR 0.43,
95% CI 0.27-0.68). The lopinavir/ritonavir-based combination showed superior virological eradication and
radiographical improvement with reduced rate of ARDS. Likewise, hydroxychloroquine improved radiographical
result. For safety, ribavirin could induce more bradycardia, anemia and transaminitis. Meanwhile, hydroxychloroquine could increase AEs rate especially diarrhea. Overall, the quality of evidence on most outcomes were
very low.
In conclusion, although we could not draw a clear conclusion for the recommendation of potential therapies
for COVID-19 considering the very low quality of evidence and wide heterogeneity of interventions and indications, our results may help clinicians to comprehensively understand the advantages and drawbacks of each
anti-coronavirus agents on efficacy and safety profiles. Lopinavir/ritonavir combinations might observe better
virological eradication capability than other anti-coronavirus agents. Conversely, ribavirin might cause more
safety concerns especially bradycardia. Thus, large RCTs objectively assessing the efficacy of antiviral therapies
for SARS-CoV-2 infections should be conducted with high priority
13 páginas
image/jepg
Pharmacological Research
reponame:Expeditio Repositorio Institucional UJTL
instname:Universidad de Bogotá Jorge Tadeo Lozano
COVID-19
SARS
MERS
Therapeutic options
Efficacy
Safety
Efficacy and safety of current therapeutic options for COVID-19 - lessons to be learnt from SARS and MERS epidemic: A systematic review and meta- analysis
Artículo
Síndrome respiratorio agudo grave
COVID-19
SARS-CoV-2
Coronavirus
info:eu-repo/semantics/embargoedAccess
info:eu-repo/semantics/acceptedVersion
Acceso restringido
https://doi.org/10.1016/j.phrs.2020.104872