COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Treatment, Primary Prevention Baroutjian A, Sanchez C, Boneva D, et al. SARS-CoV-2 pharmacologic therapies and their safety/effectiveness according to level of evidence. Am J Emerg Med. 2020 Nov;38(11):2405-2415. doi: 10.1016/j.ajem.2020.08.091. Epub 2020 Sep 1.

INTRODUCTION: There is a pressing need for COVID-19 transmission control and effective treatments. We aim to evaluate the safety and effectiveness of SARS-CoV-2 pharmacologic therapies as of August 2, 2020 according to study level of evidence.

METHODS: PubMed, ScienceDirect, Cochrane Library, JAMA Network and PNAS were searched. The following keywords were used: ((COVID-19) OR (SARS-CoV-2)) AND ((((((therapeutics) OR (treatment)) OR (vaccine)) OR (hydroxychloroquine)) OR (antiviral)) OR (prognosis)). Results included peer-reviewed studies published in English.

RESULTS: 15 peer-reviewed articles met study inclusion criteria, of which 14 were RCTs and one was a systematic review with meta-analysis. The following pharmacologic therapies were evaluated: chloroquine (CQ), hydroxychloroquine (HCQ), antivirals therapies, plasma therapy, anti-inflammatories, and a vaccine.

CONCLUSION: According to level 1 evidence reviewed here, the most effective SARS-Co-V-2 pharmacologic treatments include remdesivir for mild to severe disease, and a triple regimen therapy consisting of lopinavir-ritonavir, ribavirin and interferon beta-1b for mild to moderate disease. Also, dexamethasone significantly reduced mortality in those requiring respiratory support. However, there is still a great need for detailed level 1 evidence on pharmacologic therapies.

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

General Internal Medicine-Primary Care(US) rater

Information in this area is changing so rapidly and there is so much COVID-related treatment information already available and published that this is not much of a contribution to the literature.

General Internal Medicine-Primary Care(US) rater

As an internist and public health doc who is seeing patients with COVID and other comorbidities (e.g., TB) and doing a lot of testing and following deaths, this is really interesting. There wasn't anything really new here except to confirm what not to use and what may work without the ability to personally order it. I have had COVID-positive patients call in for hydroxychloroquine and a ZPAK simply after a positive diagnosis without any symptoms. So, having the data to decline (which we did) is very useful.

General Internal Medicine-Primary Care(US) rater

In addition to drawing conclusions about effective treatments for COVID-19 infection, this article points out the staggering number 0f scientific reports on this topic. Their final statement may be the most relevant to physicians, recommending familiarity with ongoing published reports and developing practice patterns based on professional society and institutional guidance. This is clearly a monumental but necessary task for all of us.

Hospital Doctor/Hospitalists rater

This well done review looks at studies of therapeutics for COVID-19 through August. Although they again confirm the benefits of dexamethasone and remdesivir, they also bring back into play a cocktail of lipinovir-ritonavir, ribavirin and IFN beta 1b. The latter treatment will require further studies to tease out what works because the treatment groups had more adverse effects related to the meds, and studies of just the antiviral components have been negative.

Infectious Disease rater

This is clearly the result of a lot of work, but new evidence is coming out so fast that it is probably not that useful.

Infectious Disease rater

This review is targeted at adult acute care physicians. The review is well written and current and utilizes level 1 evidence in COVID-19 treatment. The vast number of studies published on the topic highlight the importance of reviewing level 1 studies when managing these patients. The authors highlight the importance of constantly updating this information as the pandemic continues.

Intensivist/Critical Care rater

This is a systematic review of "level 1 evidence" for pharmacologic treatments in COVID-19. The inclusion and exclusion criteria are not well defined, and there is no systematic approach to critical appraisal. While it is a reasonable overview of available evidence to date, there are other systematic reviews (including the living BMJ review, and guidelines from NIH, WHO, and Surviving Sepsis Campaign) that are more rigorous in their methods and provide better guidance to clinicians.

Intensivist/Critical Care rater

Well done and current analysis of the literature on potential therapies to treat COVID-19. Well written and summarizes the current knowledge we have and the level of evidence that supports therapies that are available to clinicians.

Intensivist/Critical Care rater

This is a reasonably well performed review of the current evidence-based therapies for SARS-CoV-2. The authors include a PRISMA flow chart and the review is currently complete. There was no attempt at a systematic review combining multiple studies, which is appropriate at this point. This information will likely need to be updated in the relatively near future.

Internal Medicine rater

Not enough evidence to follow these guidelines.

Pediatric Emergency Medicine rater

This is an interesting review of the studies that have been completed. I think the authors have somewhat overstated the effectiveness of the triple medication regimen (lopinavir-ritonavir, ribavirin and interferon beta-1b) in mild to moderate disease. I think it would be fairer to indicate that none of these therapies have sufficient evidence to warrant their use at this time.

Pediatrics (General) rater

Good review.