COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Treatment Talaie H, Hosseini SM, Nazari M, et al. Is there any potential management against COVID-19? A systematic review and meta-analysis. Daru. 2020 Aug 18. pii: 10.1007/s40199-020-00367-4. doi: 10.1007/s40199-020-00367-4.
Abstract

PURPOSE: A recent survey has shown that the COVID-19 pandemic has culminated in dramatical and critical treatment particularly in acute infected patients. In fact, this systematic review-meta-analysis was directly pertained to estimation at the efficient value of some clinical managements to confront the COVID-19 infection.

METHODS: Pubmed, Embase, Scopus, Cochrane, and Scholar databases were searched from inception to July 1, 2020, to identify studies reporting the current treatment process and medications (e.g. hydroxychloroquine, antiviral therapy, convalescent plasma, and immunomodulatory agents) for COVID-19. A random-effects model meta-analysis was performed to calculate the relative risk (RR) with 95% confidence intervals (CI). The outcomes of this study were the frequency of negative conversion cases, clinical improvements, mechanical ventilation demand, intensive care unit (ICU) entry, and mortality. The standard treatment refers to the published guidelines and specialist experience which varies in different articles, and the proposed treatment refers to the kind of interest suggested in the included studies.

RESULTS: A number of 45 articles met the eligibility criteria (out of 6793 articles). Among them, 26 articles involving 3263 patients were included in quantitative analysis. Anti-COVID-19 interventions could significantly increase clinical improvement (RR 1.17, 95% CI 1.08-1.27; I2 = 49.8%) and reduce the mortality rate (RR 0.58, 95% CI 0.35-0.95; I2 = 74.8%). Although in terms of negative conversion, ICU entry, and mechanical ventilation demand, clinical intervention had no beneficial effect. The clinical effect of immunomodulatory agents (especially tocilizumab and anakinra) was noticeable compared to other medications with RR of 0.22 (95% CI 0.09-0.53; I2 = 40.9%) for mortality and 1.25 (95% CI 1.07-1.46; I2 = 45.4%) for clinical improvement. Moreover, Antivirals (RR 1.13, 95% CI 1.01-1.26; I2 = 47.0%) and convalescent plasma therapy (RR 1.41, 95% CI 1.01-1.98; I2 = 66.6%) had significant beneficial effects on clinical improvement.

CONCLUSION: Based on our findings, all the included interventions significantly declined the mortality and enhanced clinical improvements with no effect on negative conversion and mechanical ventilation demand. Especially, immunomodulators and plasma therapy showed favorable outcomes. An evaluation on the efficacy of proposed treatment against COVID-19.

Ratings
Discipline / Specialty Area Score
Public Health
Family Medicine (FM)/General Practice (GP)
Emergency Medicine
General Internal Medicine-Primary Care(US)
Hospital Doctor/Hospitalists
Internal Medicine
Infectious Disease
Respirology/Pulmonology
Comments from MORE raters

Emergency Medicine rater

The Covid treatment field is moving rapidly. The article does not include recent studies on steroids and Vitamin D.

Family Medicine (FM)/General Practice (GP) rater

The applicability and relevance of this study is unfortunately limited by a highly flawed conclusion and study methodology. In particular, the authors reach a conclusion that "all the included interventions significantly declined the mortality [of COVID-19]" by examining the totality of *all* included interventions, acting as if a single patient would simultaneously receive antimalarials, antibiotics, plasma therapy, antivirals, and immunomodulators. No included study examined this, and the idea that a patient would receive over ten different therapies at the same time for COVID-19 is irrational as it ignores drug-drug interactions and various contraindications. Furthermore, the authors' own data indicates that most therapies - when examined individually - provide non-significant effects across most fields as the CI crosses 1.

Infectious Disease rater

This is a rapidly changing field. The authors have not included the Recovery trial on dexamethasone in this meta analysis.

Internal Medicine rater

The data reflects extant knowledge and the lack thereof in the treatment of Covid-19. The plots are sobering reminders of how much further we still need to go in finding reliable treatment(s) for this disease.

Public Health rater

This was a worth doing systematic review. However and understandably, the major limiting factor for this review is variations in the study design in relation to timing of initiating treatment, existing co-morbidities among patients, severity of COVID-19, study sizes etc. Without controlling for these numerous confounding factors, many findings and attendant conclusions remain shaky. Lastly, subsequent studies should also report/undertake cost-benefit analysis to allow for an indication on intervention affordability assessment by resource limited countries.

Public Health rater

The metya-analysis is not of good quality and so are the inferences made from it.