COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Treatment Pei L, Zhang S, Huang L, et al. Antiviral agents, glucocorticoids, antibiotics, and intravenous immunoglobulin in 1142 patients with coronavirus disease 2019: a systematic review and meta-analysis. Pol Arch Intern Med. 2020 Sep 30;130(9):726-733. doi: 10.20452/pamw.15543. Epub 2020 Aug 4.

INTRODUCTION: The treatment effects of antiviral agents, glucocorticoids, antibiotics, and intravenous immunoglobulin are controversial in patients with coronavirus disease 2019 (COVID-19).

OBJECTIVES: This study aimed to evaluate the impact of drug therapy on the risk of death in patients with COVID-19.

PATIENTS AND METHODS: The PubMed, Embase, Web of Science, Cochrane Library, and major preprint platforms were searched to retrieve articles published until April 7, 2020. Subsequently, the effects of specific drug interventions on mortality of patients with COVID-19 were assessed. Odds ratios (ORs) and relative risks (RRs) with corresponding 95% CIs were pooled using random effects models.

RESULTS: Of 3421 references, 6 studies were included. Pooled results from retrospective studies revealed that antiviral agents may contribute to survival benefit (OR, 0.42; 95% CI, 0.17-0.99; P = 0.048; I2 = 82.8%), whereas a single randomized controlled trial found no effects of an antiviral agent on mortality (RR, 0.77; 95% CI, 0.45-1.3; P = 0.33). Glucocorticoid use led to an increased risk of death (OR, 2.43; 95% CI, 1.44-4.1; P = 0.001; I2 = 61.9%). Antibiotics did not significantly affect mortality (OR, 1.13; 95% CI, 0.67-1.89; P = 0.64; I2 = 0%). Similarly, intravenous immunoglobulin had a nonsignificant effect on mortality (OR, 2.66; 95% CI, 0.72-9.89; P = 0.14; I2 = 93.1%).

CONCLUSIONS: With the varied heterogeneities across interventions, the current evidence indicated a probable survival benefit from antiviral agent use and a harmful effect of glucocorticoids in patients with COVID-19. Neither any of antibiotics nor intravenous immunoglobulin were associated with survival benefit in this population.

Discipline / Specialty Area Score
Intensivist/Critical Care
Infectious Disease
Comments from MORE raters

Infectious Disease rater

This cannot be considered as level 1 evidence.

Intensivist/Critical Care rater

Strengths: It is a good initiative to pool data and analyze then to find beneficial modality. Weakness: . As like many meta-analysis, it has flaws in selection and exclusion criteria. . Studies on steroid in COVID-19 are old and not updated. . Beneficial effect of antivirals are controversial.