COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Treatment 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 Nov;50(11):e13383. doi: 10.1111/eci.13383. Epub 2020 Sep 13.

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 and 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) was 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 favourable 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.

Discipline / Specialty Area Score
Hospital Doctor/Hospitalists
Internal Medicine
Intensivist/Critical Care
Comments from MORE raters

Hospital Doctor/Hospitalists rater

This study provides valuable information for clinicians that are taking care of COVID patients. The challenge is that evidence changes rapidly and our current peer-review process takes too long. We need to develop new formats that ensure a solid peer-review process at a faster rate.

Hospital Doctor/Hospitalists rater

This is a necessary review of several of the most commonly used treatments for COVID-19. This is essential reading for any current hospitalist.

Intensivist/Critical Care rater

This is a well timed review of the effectiveness and adverse effects of the most recently tried options in COVID-19, which has become a threat to humanity with emergent waves coming. Strengths: • Large numbers of studies searched, and strict inclusion and exclusion criteria used. • Standard accepted protocol used for analysis to eliminate bias and calculate the significance. Weakness: • Probably affected by study selection bias. • Omission of some less important studies and inclusion of own chosen study may have affected the final outcome. • Some final verdict made which looked bit contradictory considering recent evidence. • Some other salient option missed. • The important findings were not properly defended or contradicted. Overall this is a good analysis. The final outcome should be carefully analyzed after matching with current emerging evidence especially with steroid. More expensive and less effective drugs have been shown to be more promising.