Current best evidence for clinical care (more info)
BACKGROUND: As SARS-CoV-2 continues to spread worldwide, it has already resulted in over 110 million cases and 2.5 million deaths. Currently, there are no effective COVID-19 treatments, although numerous studies are under way. SARS-CoV-2, however, is not the first coronavirus to cause serious outbreaks. COVID-19 can be compared with previous human coronavirus diseases, such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), to better understand the development of treatments.
METHODS: Databases Medline, Embase and WHO COVID-19 was systematically searched on 9 February 2021 for studies reporting on therapeutic effect of COVID-19 treatments. Clinical trials, case reports, observational studies and systematic reviews in the English language were eligible.
RESULTS: 1416 studies were identified and 40 studies were included in this review. Therapies included are: remdesivir, convalescent plasma, hydroxychloroquine, lopinavir/ ritonavir, interferon, corticosteroids, cytokine storm inhibitors and monoclonal antibodies. Remdesivir, convalescent plasma and interferon seems to provide some clinical benefits such as faster recovery time and reduced mortality, but these effects are not clinically significant. Some corticosteroids are effective in reducing mortality in severe COVID-19 patients. Hydroxychloroquine do not convey any beneficial, and therapies such as cytokine storm inhibitors and monoclonal antibodies were also not effective and require further investigation.
CONCLUSIONS: There is no single therapy effective against COVID-19. However, a combination of therapies administered at different stages of infection may provide some benefit. This conclusion is reflected in the limited effects of these treatments in previous human coronaviruses.
| Discipline / Specialty Area | Score |
|---|---|
| Hospital Doctor/Hospitalists | |
| Internal Medicine | |
| Family Medicine (FM)/General Practice (GP) | |
| General Internal Medicine-Primary Care(US) | |
| Emergency Medicine | |
| Infectious Disease | |
| Intensivist/Critical Care | |
The authors have crammed too much information into too little space. It is very difficult to read the paper and to understand which treatments are or may be beneficial at which stages of illness. I'm not sure this paper helps.
This is a through review of the literature of agents used in the treatment of SARS-CoV-2 infection. However, it provides no novel conclusions. It is a useful article if one wants to see the effect of all agents. As usual in such retrospective analyses, the conclusion is that more, better studies are needed.
The existing living COVID-19 guideline is the reference for this type of manuscripts: https://www.bmj.com/content/370/bmj.m3379
It's about time we take stock and start looking at the treatments we have been offering our patients along the course of this pandemic. Good review and realistic conclusion.