Evaluation of current medical approaches for COVID-19: a systematic review and meta-analysis

BMJ Support Palliat Care. 2021 Mar;11(1):45-52. doi: 10.1136/bmjspcare-2020-002554. Epub 2020 Sep 21.

Abstract

Background: Because of the lack of vaccination, it is urgent to find effective antiviral agents for COVID-19 treatment.

Method: Online databases were searched for articles published before or on 22 June 2020. Studies reporting the effectiveness and safety of antiviral agents for COVID-19 were analysed.

Results: A total of 42 studies were included in this analysis. Hydroxychloroquine (HCQ) was not associated with the incidence of death (risk ratio (RR)=1.08; 95% CI 0.81 to 1.44) and severe cases (RR=1.05; 95% CI 0.61 to 1.81). Patients treated with HCQ obtained few benefits with respect to the clearance of viral RNA and were more likely to have adverse reactions. HCQ treatment could shorten the body temperature recovery time (weighted mean difference = -1.04; 95% CI -1.64 to -0.45). Lopinavir/ritonavir (LPV/r) (RR=0.90; 95% CI 0.76 to 1.07) and Arbidol (RR=1.09; 95% CI 0.92 to 1.29) were not associated with the negative conversion rate. Integrative Chinese-Western medicine alleviated clinical symptoms and decreased the incidence of severe cases (RR=0.38; 95% CI 0.25 to 0.59). Remdesivir treatment reduced the 14-day mortality rate of patients with severe COVID-19 (RR=0.64; 95% CI 0.44 to 0.94). Convalescent plasma (CP) tended to increase the negative conversion rate (RR=2.47; 95% CI 1.70 to 3.57).

Conclusion: HCQ, LPV/r and Arbidol bring little benefit in COVID-19 treatment. Integrative Chinese-Western medicine improved the clinical symptoms of patients with COVID-19. Remdesivir and CP might be the potential treatments for patients with severe COVID-19. However, large-scale clinical randomised trials are needed to validate our conclusions.

Keywords: hospital care; lung; pharmacology.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adenosine Monophosphate / analogs & derivatives
  • Adenosine Monophosphate / therapeutic use
  • Alanine / analogs & derivatives
  • Alanine / therapeutic use
  • Antirheumatic Agents / therapeutic use*
  • Antiviral Agents / therapeutic use*
  • COVID-19 / drug therapy
  • COVID-19 / therapy*
  • Drug Combinations
  • Humans
  • Hydroxychloroquine / therapeutic use
  • Immunization, Passive
  • Immunoglobulins, Intravenous / therapeutic use
  • Immunologic Factors / therapeutic use*
  • Indoles / therapeutic use
  • Lopinavir / therapeutic use
  • Medicine, Chinese Traditional*
  • Ritonavir / therapeutic use
  • SARS-CoV-2
  • Treatment Outcome

Substances

  • Antirheumatic Agents
  • Antiviral Agents
  • Drug Combinations
  • Immunoglobulins, Intravenous
  • Immunologic Factors
  • Indoles
  • lopinavir-ritonavir drug combination
  • Lopinavir
  • remdesivir
  • Adenosine Monophosphate
  • Hydroxychloroquine
  • umifenovir
  • Ritonavir
  • Alanine

Supplementary concepts

  • COVID-19 drug treatment
  • COVID-19 serotherapy