In a living systematic review and network meta-analysis, researchers have compared the effects of different drug treatments currently being discussed and used for COVID-19.
A living systematic review presents a complete, broad, and updated view of the evidence for fast-moving areas of research, such as COVID-19. The results will be periodically updated, changes from each version will be highlighted for readers and the most updated version will be the one available in the publication platform.
23 randomised controlled trials were included in the analysis, published in the peer-reviewed journal, The BMJ, on 30 July.
The findings in brief:
The only intervention that may reduce mortality and mechanical ventilation is glucocorticoids (steroids like dexamethasone). However, this is based on just the RECOVERY trial, which, as we had earlier reported, had found dexamethasone, a cheap and widely available drug to improve survival and reduce the risk of death for critically ill COVID patients.
The evidence for both hydroxychloroquine and lopinavir-ritonavir in reducing symptom duration compared to standard care was ‘low’.
Remdesivir is the only intervention in which ‘moderate’ certainty exists to show benefits for both time-to-symptom resolution and duration of mechanical ventilation, but it remains uncertain whether it has any effect on mortality and other outcomes important to patients. The researchers write in their conclusion, “Remdesivir probably reduces the length of hospital stay.” Importantly, this is the only drug where all the data came from RCTs sponsored by a pharmaceutical company.
Hydroxychloroquine might increase the risk of adverse events compared with the other interventions, while remdesivir probably does not substantially increase this risk. No other interventions included enough patients to meaningfully interpret adverse effects leading to drug discontinuation.
The study authors have noted that evidence of most drugs is highly uncertain because most of the randomised controlled trials so far have been small and have important study limitations. The authors note, “The effects of most drug interventions are currently highly uncertain, and no definitive evidence exists that other interventions result in important benefits and harms for any outcomes.”
This analysis contributes by putting forward a comprehensive comparison of available trial results and finding that steroids could reduce mortality in patients, and remdesivir may bring down the length of hospital stay, though experts strongly support the continued enrolment of patients into ongoing clinical trials of this drug for more evidence.
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