COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Treatment, Primary Prevention Welte T, Ambrose LJ, Sibbring GC, et al. Current evidence for COVID-19 therapies: a systematic literature review. Eur Respir Rev. 2021 Mar 17;30(159). pii: 30/159/200384. doi: 10.1183/16000617.0384-2020. Print 2021 Mar 31.
Abstract

Effective therapeutic interventions for the treatment and prevention of coronavirus disease 2019 (COVID-19) are urgently needed. A systematic review was conducted to identify clinical trials of pharmacological interventions for COVID-19 published between 1 December 2019 and 14 October 2020. Data regarding efficacy of interventions, in terms of mortality, hospitalisation and need for ventilation, were extracted from identified studies and synthesised qualitatively. In total, 42 clinical trials were included. Interventions assessed included antiviral, mucolytic, antimalarial, anti-inflammatory and immunomodulatory therapies. Some reductions in mortality, hospitalisation and need for ventilation were seen with interferons and remdesivir, particularly when administered early, and with the mucolytic drug, bromhexine. Most studies of lopinavir/ritonavir and hydroxychloroquine did not show significant efficacy over standard care/placebo. Dexamethasone significantly reduced mortality, hospitalisation and need for ventilation versus standard care, particularly in patients with severe disease. Evidence for other classes of interventions was limited. Many trials had a moderate-to-high risk of bias, particularly in terms of blinding; most were short-term and some included low patient numbers.This review highlights the need for well-designed clinical trials of therapeutic interventions for COVID-19 to increase the quality of available evidence. It also emphasises the importance of tailoring interventions to disease stage and severity for maximum efficacy.

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

Emergency Medicine rater

Unfortunately, as seems to be the case with COVID-19 literature, this systematic review was outdated by the time it was published. Substantial new data have emerged that doesn't change the basic conclusions that almost nothing works against this disease, except maybe steroids in severe cases and now conflicting evidence that perhaps there is a patient subset that may benefit from tocilizumab. No other pharmacologic intervention has anything approaching convincing data to support its routine use. This review highlights the broad array of drugs being tested in very small studies that should not get people excited until validated in much larger randomized studies, as the potential for substantial publication bias exists here.

Emergency Medicine rater

The data are presented in a way that is difficult to decipher. I doubt most emergency physicians will take the time to read carefully.

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

Provides a very useful review of the evidence for COVID-19 therapies as of last fall. The limitation is the rapidly evolving nature of this space, and that needs to be taken into account.

General Internal Medicine-Primary Care(US) rater

This seems to confirm the articles/comment/opinion we’ve been reading.

General Internal Medicine-Primary Care(US) rater

This is an excellent research-oriented review of the current state of treatment effectiveness for COVID-19. This is probably not as helpful to the clinical practitioner. This study certainly removes obscurities about whether or not a specific treatment option is appropriate for reducing mortality and morbidity among these patients.

Intensivist/Critical Care rater

This is an interesting literature review of therapies for COVID-19, but there are many others that are both more comprehensive and more clinically useful. It does not provide much new information for clinicians and would primarily be of relevance for researchers interested in identifying gaps for further work.

Internal Medicine rater

This one also seems to have an out-of-date search end. This field moves too quickly for a date that is more than 6 months ago. Everyone knows that older data are questionable.

Internal Medicine rater

I think this gets better at the subtleties/uncertainties.

Internal Medicine rater

Very concise but well organized review of available therapies for COVID-19.

Public Health rater

Literature search for COVID-19 therapies SR ended 14 Oct/2020. The authors concluded that well designed RCTs are needed: "Some reductions in mortality, hospitalisation and need for ventilation were seen with interferons and remdesivir, particularly when administered early, and with the mucolytic drug, bromhexine. Most studies of lopinavir/ritonavir and hydroxychloroquine did not show significant efficacy over standard care/placebo. Dexamethasone significantly reduced mortality, hospitalisation and need for ventilation versus standard care, particularly in patients with severe disease...Many trials had a moderate-to-high risk of bias, particularly in terms of blinding; most were short-term and some included low patient numbers. This review highlights the need for well-designed clinical trials of therapeutic interventions for COVID-19 to increase the quality of available evidence. It also emphasises the importance of tailoring interventions to disease stage and severity for maximum efficacy."