COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Manuscript Misra S, Nath M, Hadda V, et al. Efficacy of various treatment modalities for nCOV-2019: a systematic review and meta-analysis. Eur J Clin Invest. 2020 Aug 18:e13383. doi: 10.1111/eci.13383.

BACKGROUND: Several therapeutic agents have been investigated for treatment of novel Coronavirus-2019 (nCOV-2019). We conducted a systematic review and meta-analysis to assess the efficacy of various treatment modalities in nCOV-2019 patients.

METHODS: A literature search was conducted before 29 June 2020 in PubMed, Google Scholar, Cochrane library databases. A fixed-effect model was applied if I2 <50%, else results were combined using random-effect model. Risk Ratio (RR) or Standardized Mean Difference (SMD) along-with 95% Confidence Interval (95%CI) were used to pool the results. Between-study heterogeneity was explored using influence and sensitivity analyses and publication bias was assessed using funnel plots. Entire statistical analysis was conducted in R version 3.6.2.

RESULTS: Fifty studies involving 15 in-vitro and 35 clinical studies including 9170 nCOV-2019 patients were included. Lopinavir-Ritonavir was significantly associated with shorter mean time to clinical recovery (SMD -0.32; 95%CI -0.57 to -0.06), Remdesivir was significantly associated with better overall clinical recovery (RR 1.17; 95%CI 1.07 to 1.29) and Tocilizumab was associated with less all-cause mortality (RR 0.38; 95%CI 0.16 to 0.93). Hydroxychloroquine was associated with longer time to clinical recovery and less overall clinical recovery. It additionally had higher all-cause mortality and more total adverse events.

CONCLUSION: Our meta-analysis suggests that except in vitro studies, no treatment has shown overall favorable outcomes in nCOV-2019 patients. Lopinavir-Ritonavir, Remdesivir and Tocilizumab may have some benefits while Hydroxychloroquine administration may cause harm in nCOV-2019 patients. Results from upcoming large clinical trials may further clarify role of these drugs.

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