Clinical effectiveness of drugs in hospitalized patients with COVID-19: a systematic review and meta-analysis

  1. Roberto Ariel Abeldaño Zuñiga
  2. Silvia Mercedes Coca
  3. Giuliana Florencia Abeldaño
  4. Ruth Ana María González-Villoria

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Abstract

The aim was to assess the clinical effectiveness of drugs used in hospitalized patients with COVID-19 infection. We conducted a systematic review of randomized clinical trials assessing treatment with remdesivir, chloroquine, hydroxychloroquine, lopinavir, ritonavir, dexamethasone, and convalescent plasma, for hospitalized patients with a diagnosis of SARS-CoV-2 infection. The outcomes were mortality, clinical improvement, duration of ventilation, duration of oxygen support, duration of hospitalization, virological clearance, and severe adverse events. A total of 48 studies were retrieved from the databases. Eleven articles were finally included in the data extraction and qualitative synthesis of results. The meta-analysis suggests a benefit of dexamethasone versus standard care in the reduction of risk of mortality at day 28; and the clinical improvement at days 14 and 28 in patients treated with remdesivir. We can conclude that dexamethasone would have a better result in hospitalized patients, especially in low-resources settings. The analysis of the main treatments proposed for hospitalized patients is of vital importance to reduce mortality in low-income countries, since the COVID-19 pandemic had an economic impact worldwide with the loss of jobs and economic decline in countries with scarce resources.

The reviews of this paper are available via the supplemental material section.

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  1. Version published to 10.1177/17534666211007214
  2. ScreenIT

    SciScore for 10.1101/2020.09.11.20193011: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All references were managed with Mendeley® software.
    Mendeley®
    suggested: (Mendeley Data, RRID:SCR_002750)
    The data were stored in Microsoft Office Excel spreadsheets and organized in an instrument constructed by the authors considering: Characteristics of the study (author, year, country), sample, study design, and characteristics of the results.
    Microsoft Office Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Among the limitations of this study, we can mention the rapid generation of new knowledge in times of the pandemic, which can potentially affect the timeliness of this review in a short time. Another limitation is the heterogeneity shown in the reviewed studies and their high risk of bias, which continues to affect the quality of the recommendations. In this review, we chose not to issue recommendations with the GRADE methodology, due to heterogeneity and high risk of bias. Among the strengths of this study, focusing solely on inpatient studies, allowed us to review a larger volume of outcomes in these studies. The analysis of the main treatments proposed for hospitalized patients is of vital importance to reduce mortality in low-income countries; since the COVID-19 pandemic had an economic impact worldwide with the loss of jobs and economic decline [31] in countries with scarce resources. In these settings, the use of dexamethasone may be an affordable option for these countries. While there is no vaccine available, social distancing is so far the most crucial measure in controlling the spread of the disease [5]. In conclusion, dexamethasone would have a better result in hospitalized patients, although a detailed report of its adverse events is necessary. In Latin American countries, it is necessary to wait for the conclusion of some studies in the recruitment phase (3 clinical trials in Argentina and 1 in Mexico).

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.21203/rs.3.rs-76791/v1 on Research Square
  4. Version published to 10.1101/2020.09.11.20193011v1 on medRxiv