COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Treatment Wang M, Wu T, Zuo Z, et al. Evaluation of current medical approaches for COVID-19: a systematic review and meta-analysis. BMJ Support Palliat Care. 2020 Sep 21. pii: bmjspcare-2020-002554. doi: 10.1136/bmjspcare-2020-002554.
Abstract

BACKGROUND: Because of the lack of vaccination, it is urgent to find effective antiviral agents for COVID-19 treatment.

METHOD: Online databases were searched for articles published before or on 22 June 2020. Studies reporting the effectiveness and safety of antiviral agents for COVID-19 were analysed.

RESULTS: A total of 42 studies were included in this analysis. Hydroxychloroquine (HCQ) was not associated with the incidence of death (risk ratio (RR)=1.08; 95% CI 0.81 to 1.44) and severe cases (RR=1.05; 95% CI 0.61 to 1.81). Patients treated with HCQ obtained few benefits with respect to the clearance of viral RNA and were more likely to have adverse reactions. HCQ treatment could shorten the body temperature recovery time (weighted mean difference = -1.04; 95% CI -1.64 to -0.45). Lopinavir/ritonavir (LPV/r) (RR=0.90; 95% CI 0.76 to 1.07) and Arbidol (RR=1.09; 95% CI 0.92 to 1.29) were not associated with the negative conversion rate. Integrative Chinese-Western medicine alleviated clinical symptoms and decreased the incidence of severe cases (RR=0.38; 95% CI 0.25 to 0.59). Remdesivir treatment reduced the 14-day mortality rate of patients with severe COVID-19 (RR=0.64; 95% CI 0.44 to 0.94). Convalescent plasma (CP) tended to increase the negative conversion rate (RR=2.47; 95% CI 1.70 to 3.57).

CONCLUSION: HCQ, LPV/r and Arbidol bring little benefit in COVID-19 treatment. Integrative Chinese-Western medicine improved the clinical symptoms of patients with COVID-19. Remdesivir and CP might be the potential treatments for patients with severe COVID-19. However, large-scale clinical randomised trials are needed to validate our conclusions.

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

General Internal Medicine-Primary Care(US) rater

This meta-analysis has several limitations, included studies are retrospective cohort studies with a low level of evidence and the treatment regimens of each agent and the duration of follow-up are not consistent. They report possible publication bias. HCQ is associated with more adverse reactions, no clinical benefits of LPV/r and Arbidol are observed. Integrative Chinese-Western (what kind of ?) medicine improves the clinical symptoms for mild or moderate disease. Remdesivir and CP therapy with possible benefits in patients with severe COVID-19. The novel IVIG therapy shows promising results.

Hospital Doctor/Hospitalists rater

The current review summarizes known facts about some agents that have been used in the treatment of COVID-19 infection.

Infectious Disease rater

The article reports a meta-analysis on treatment options for COVID-19. The inclusion of mild-moderate cases for analysis is somewhat different than the bulk of analyses out there, but the overall results are consistent with what has largely been reported- HCQ is borderline with higher risk, Remdesivir and CP are probably beneficial, and not much else in between looks great. The article does highlight the reported benefit and low heterogeneity in TCM in relieving symptoms, though the individual studies leading to that conclusion are of uneven quality at best. Still, I can't fault the analysis presented here in pooling them as they note that limitation and report consistently.

Infectious Disease rater

As an intensive care physician interested in infectiology and as an anesthesiologist of a university institution, who is also involved in the therapy of COVID 19 patients, I would like to comment on this meta-analysis as follows. The authors have presented the current evidence for the treatment of SARS-CoV 2 patients in a very clear and concise manner. This paper can be used as a basis for specific therapeutic decisions based on the current evidence. Critically, tocilicumab therapy (EMPACTA study) is not mentioned. Umfenovir is only approved in Russia and possibly in China and is therefore not an option. All in all a paper worth reading.

Intensivist/Critical Care rater

In view of the rapidly evolving evidence regarding therapeutic options for COVID-19, this updated systematic review and meta-analysis is definitively helpful. As major publication biases were ruled out, this piece of evidence brings useful information to several categories of caregivers managing patients with different stages of severity of COVID-19.