Pharmacological treatment for patients with coronavirus disease 2019: systematic review of randomized controlled trials Pharmacological treatment for patients with coronavirus disease 2019: systematic review of randomized controlled trials
Background : The best treatment for COVID-19 is not known, with numerous agents under investigation. We determined the outcomes of patients with COVID-19 treated with different pharmacological agents. Methods : In this systematic review, we searched Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials for studies published between 1 st January and 12 th August, 2020. We included randomized controlled trials (RCTs) of patients with COVID-19 treated with any pharmacological agent and compared with a different pharmacological agent, placebo or standard of care. Results : From 6346 citations, 19 studies were included, with an overall low risk of bias. Two RCTs evaluated the use of remdesivir in laboratory-confirmed moderate-to-severe COVID-19. One study found that 10 days of remdesivir was associated with shortened recovery time. Neither found reduction in mortality. One RCT found no association of lopinavir/ritonavir with time to clinical improvement, or mortality benefit. Two RCTs of hydrochloroquine in patients with mild, early disease demonstrated no reduction in disease severity, hospitalization rate, death or viral load. Two RCTs observed no association of hydrochloroquine in hospitalized patients with mild-to-moderate disease with virological clearance, improvement in symptoms, need for respiratory support or death. One RCT showed that the use of steroids was associated with improved survival in patients with moderate-to-severe disease, especially those requiring respiratory support. Conclusions : There is evidence for the benefit of steroids in patients with moderate-to-severe disease. Remdesivir might shorten recovery time in patients hospitalized with moderate-to-severe disease. There is currently no evidence to support the use of lopinavir/ritonavir or hydrochloroquine. Study’s Registration : PROSPERO CRD42020184433.
Background : The best treatment for COVID-19 is not known, with numerous agents under investigation. We determined the outcomes of patients with COVID-19 treated with different pharmacological agents. Methods : In this systematic review, we searched Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials for studies published between 1 st January and 12 th August, 2020. We included randomized controlled trials (RCTs) of patients with COVID-19 treated with any pharmacological agent and compared with a different pharmacological agent, placebo or standard of care. Results : From 6346 citations, 19 studies were included, with an overall low risk of bias. Two RCTs evaluated the use of remdesivir in laboratory-confirmed moderate-to-severe COVID-19. One study found that 10 days of remdesivir was associated with shortened recovery time. Neither found reduction in mortality. One RCT found no association of lopinavir/ritonavir with time to clinical improvement, or mortality benefit. Two RCTs of hydrochloroquine in patients with mild, early disease demonstrated no reduction in disease severity, hospitalization rate, death or viral load. Two RCTs observed no association of hydrochloroquine in hospitalized patients with mild-to-moderate disease with virological clearance, improvement in symptoms, need for respiratory support or death. One RCT showed that the use of steroids was associated with improved survival in patients with moderate-to-severe disease, especially those requiring respiratory support. Conclusions : There is evidence for the benefit of steroids in patients with moderate-to-severe disease. Remdesivir might shorten recovery time in patients hospitalized with moderate-to-severe disease. There is currently no evidence to support the use of lopinavir/ritonavir or hydrochloroquine. Study’s Registration : PROSPERO CRD42020184433.