COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Treatment Diallo A, Carlos-Bolumbu M, Traore M, et al. An updated systematic review and network meta-analysis of 25 randomized trials assessing the efficacy and safety of treatments in COVID-19 disease. J Public Health Res. 2021 Feb 3;10(1):1945. doi: 10.4081/jphr.2021.1945. eCollection 2021 Jan 14.
Abstract

To date, there is no definite effective treatment for the COVID- 19 pandemic. We performed an update network meta-analysis to compare and rank COVID-19 treatments according to their efficacy and safety. Literature search was performed from MEDLINE and CENTRAL databases from inception to September 5, 2020. Randomized clinical trials (RCTs) which compared the effect of any pharmacological drugs versus standard care or placebo 28-day after hospitalization in adult patients with COVID-19 disease were included. Risk ratio (RR) and 95% CI were calculated for 28-day all-cause mortality, clinical improvement, any adverse event (AEs), and viral clearance. A total of 25 RCTs, evaluating 17 different treatments, and 11,597 participants were analyzed. Remdesivir for 10- day compared to standard care (RR 0.69, 95% CI [0.48-0.99]), and a low dose compared to a high dose of HCQ (0.38, [0.17-0.89]) were associated with a lower risk of death. A total of 2,766 patients experienced clinical improvement, a 5-day course of remdesivir was associated with a higher frequency of clinical improvement compared to standard care (RR 1.21, 95% CI [1.00-1.47]). Compared to standard care, remdesivir for both 5 and 10 days, lopinavir/ritonavir, and dexamethasone reduced the risk of any severe AEs by 52% (0.48, 0.34-0.67), 24% (0.77, 0.63-0.92), 40% (0.60, 0.37-0.98), and 50% (0.50, 0.25-0.98) respectively. In this study of hospitalized patients with COVID-19, administration of remdesivir for 10-day compared to standard care was associated with lower 28-day all-cause mortality and serious AEs, and higher clinical improvement rate.

Ratings
Discipline / Specialty Area Score
Intensivist/Critical Care
Hospital Doctor/Hospitalists
Internal Medicine
Respirology/Pulmonology
Infectious Disease
Comments from MORE raters

Hospital Doctor/Hospitalists rater

Useful review mainly to have all findings in one place.

Intensivist/Critical Care rater

Helpful to put all interventions in one NMA. However, there are other more elegant NMAs out there with better methodology (including GRADE, etc).

Internal Medicine rater

There are daily SRs on Covid treatments, so it is difficult to say whether anything is new.

Respirology/Pulmonology rater

Generally useful review, although I suspect practitioners taking care of COVID patients and keeping on top of the literature will already know these findings. Some comments on a cursory read of the review can be misleading, such as: 1) Low-dose HCQ compared with high dose is associated with lower mortality; 2) Compared with standard of care, lopinavir/ritonavir reduces the risk for any severe adverse events.