Systematic review and meta-analysis of effectiveness of treatment options against SARS-CoV-2 infection

J Med Virol. 2021 Feb;93(2):775-785. doi: 10.1002/jmv.26302. Epub 2020 Jul 22.

Abstract

Treatment options for severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) are limited with no clarity on efficacy and safety profiles. We performed a systematic review and meta-analysis of studies on patients ≥18 years reporting data on therapeutic interventions in SARS-CoV-2. Primary outcome was all-cause mortality and secondary outcomes were rates of mechanical ventilation, viral clearance, adverse events, discharge, and progression to severe disease. Pooled rates and odds ratios (OR) were calculated. Twenty-nine studies with 5207 patients were included. Pooled all-cause mortality in intervention arm was 12.8% (95% confidence interval [CI]: 8.1%-17.4%). Mortality was significantly higher for studies using hydroxychloroquine (HCQ) for intervention (OR: 1.36; 95% CI: 0.97-1.89). Adverse events were also higher in HCQ subgroup (OR: 3.88; 95% CI: 1.60-9.45). There was no difference in other secondary outcomes. There is a need for well-designed randomized clinical trials for further investigation of every therapeutic intervention for further insight into different therapeutic options.

Keywords: COVID-19; HCQ; SARS-CoV-2; hydroxychloroquine; meta-analysis.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adenosine Monophosphate / administration & dosage
  • Adenosine Monophosphate / adverse effects
  • Adenosine Monophosphate / analogs & derivatives*
  • Adrenal Cortex Hormones / administration & dosage*
  • Adrenal Cortex Hormones / adverse effects
  • Alanine / administration & dosage
  • Alanine / adverse effects
  • Alanine / analogs & derivatives*
  • Antibodies, Monoclonal, Humanized / administration & dosage*
  • Antibodies, Monoclonal, Humanized / adverse effects
  • Antiviral Agents / administration & dosage*
  • Antiviral Agents / adverse effects
  • COVID-19 / mortality
  • COVID-19 / pathology
  • COVID-19 / therapy*
  • COVID-19 / virology
  • Drug Administration Schedule
  • Drug Combinations
  • Female
  • Humans
  • Hydroxychloroquine / administration & dosage*
  • Hydroxychloroquine / adverse effects
  • Immunization, Passive
  • Lopinavir / administration & dosage*
  • Lopinavir / adverse effects
  • Male
  • Middle Aged
  • Odds Ratio
  • Ritonavir / administration & dosage*
  • Ritonavir / adverse effects
  • SARS-CoV-2 / drug effects
  • SARS-CoV-2 / pathogenicity
  • Survival Analysis
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Antibodies, Monoclonal, Humanized
  • Antiviral Agents
  • Drug Combinations
  • lopinavir-ritonavir drug combination
  • Lopinavir
  • remdesivir
  • Adenosine Monophosphate
  • Hydroxychloroquine
  • tocilizumab
  • Ritonavir
  • Alanine

Supplementary concepts

  • COVID-19 serotherapy