COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Treatment Zhang C, Jin H, Wen YF, et al. Efficacy of COVID-19 Treatments: A Bayesian Network Meta-Analysis of Randomized Controlled Trials. Front Public Health. 2021 Sep 28;9:729559. doi: 10.3389/fpubh.2021.729559. eCollection 2021.
Abstract

Background: We provided a comprehensive evaluation of efficacy of available treatments for coronavirus disease 2019 (COVID-19). Methods: We searched for candidate COVID-19 studies in WHO COVID-19 Global Research Database up to August 19, 2021. Randomized controlled trials for suspected or confirmed COVID-19 patients published on peer-reviewed journals were included, regardless of demographic characteristics. Outcome measures included mortality, mechanical ventilation, hospital discharge and viral clearance. Bayesian network meta-analysis with fixed effects was conducted to estimate the effect sizes using posterior means and 95% equal-tailed credible intervals (CrIs). Odds ratio (OR) was used as the summary measure for treatment effect. Bayesian hierarchical models were used to estimate effect sizes of treatments grouped by the treatment classifications. Results: We identified 222 eligible studies with a total of 102,950 patients. Compared with the standard of care, imatinib, intravenous immunoglobulin and tocilizumab led to lower risk of death; baricitinib plus remdesivir, colchicine, dexamethasone, recombinant human granulocyte colony stimulating factor and tocilizumab indicated lower occurrence of mechanical ventilation; tofacitinib, sarilumab, remdesivir, tocilizumab and baricitinib plus remdesivir increased the hospital discharge rate; convalescent plasma, ivermectin, ivermectin plus doxycycline, hydroxychloroquine, nitazoxanide and proxalutamide resulted in better viral clearance. From the treatment class level, we found that the use of antineoplastic agents was associated with fewer mortality cases, immunostimulants could reduce the risk of mechanical ventilation and immunosuppressants led to higher discharge rates. Conclusions: This network meta-analysis identified superiority of several COVID-19 treatments over the standard of care in terms of mortality, mechanical ventilation, hospital discharge and viral clearance. Tocilizumab showed its superiority compared with SOC on preventing severe outcomes such as death and mechanical ventilation as well as increasing the discharge rate, which might be an appropriate treatment for patients with severe or mild/moderate illness. We also found the clinical efficacy of antineoplastic agents, immunostimulants and immunosuppressants with respect to the endpoints of mortality, mechanical ventilation and discharge, which provides valuable information for the discovery of potential COVID-19 treatments.

Ratings
Discipline / Specialty Area Score
Hospital Doctor/Hospitalists
Internal Medicine
Infectious Disease
Emergency Medicine
Comments from MORE raters

Emergency Medicine rater

Nice overview over a lot of different treatment options.

Emergency Medicine rater

As an emergency physician, I find this study can help guide outpatient therapeutic options for COVID-19.

Hospital Doctor/Hospitalists rater

This is a comprehensive review of treatments for COVID-19. The authors used a network metanalysis to look for signals of efficacy. They were able to assess mortality, need for mechanical ventilation, discharge at 14 days and viral clearance. With this technique, they can also look at the data to determine the likelihood that a particular intervention is better than standard of care. There were no huge surprises in the results as they confirmed findings of improvement in mortality and reduced need for mechanical ventilation. There was a signal that Ivermectin may improve survival; although, it did not seem to improve need for mechanical ventilation and had little effect on discharge. Ivermectin does increase viral clearance. The authors suggest that there are several treatments that would benefit from further study to see if they are effective.

Infectious Disease rater

Considering the challenges of treating patients with covid-19, this systematic review provides data that allow us to differentiate the main classes of drugs and associated outcomes.