{"id":5808,"date":"2023-03-27T15:25:19","date_gmt":"2023-03-27T13:25:19","guid":{"rendered":"https:\/\/www.jphres.org\/?p=5808"},"modified":"2023-04-02T14:15:06","modified_gmt":"2023-04-02T12:15:06","slug":"an-updated-systematic-review-and-network-meta-analysis-of-25-randomized-trials-assessing-the-efficacy-and-safety-of-treatments-in-covid-19-disease","status":"publish","type":"page","link":"https:\/\/www.jphres.us.com\/index.php\/jphres\/article\/view\/1945\/","title":{"rendered":"An updated systematic review and network meta-analysis of 25 randomized trials assessing the efficacy and safety of treatments in COVID-19 disease"},"content":{"rendered":"<div class=\"item doi\"><span class=\"value\"><a href=\"https:\/\/doi.org\/10.4081\/jphr.2021.1945\">https:\/\/doi.org\/10.4081\/jphr.2021.1945<\/a><\/span><\/div>\n<ul class=\"item authors\">\n<li><span class=\"name\"><strong>Alhassane Diallo<\/strong><br \/>\n<\/span><span class=\"affiliation\">INSERM, CIC 1411, CHU of Montpellier, St. Eloi Hospital, University of Montpellier, France.<\/span><span class=\"orcid\"><br \/>\n<a href=\"https:\/\/orcid.org\/0000-0002-1666-8641\" target=\"_blank\" rel=\"noopener\">https:\/\/orcid.org\/0000-0002-1666-8641<\/a><\/span><\/li>\n<li><span class=\"name\"><strong>Miguel Carlos-Bolumbu<\/strong><br \/>\n<\/span><span class=\"affiliation\">Urgences R\u00e9animation Centre Hospitalier Sud Essonnes CHSE, Paris, France.<\/span><\/li>\n<li><span class=\"name\"><strong>Marie Traor\u00e9<\/strong><br \/>\n<\/span><span class=\"affiliation\">Service de Rhumatologie, APHP Henry Mondor, Paris, France.<br \/>\n<\/span><span class=\"orcid\"><a href=\"https:\/\/orcid.org\/0000-0003-2196-6720\" target=\"_blank\" rel=\"noopener\">https:\/\/orcid.org\/0000-0003-2196-6720<\/a><\/span><\/li>\n<li><span class=\"name\"><strong>Mamadou Hassimiou Diallo<\/strong><br \/>\n<\/span><span class=\"affiliation\">H\u00f4pitaux Universitaires Piti\u00e9 Salp\u00eatri\u00e8re &#8211; Charles Foix, Unit\u00e9 de Recherche Clinique Salp\u00eatri\u00e8re &#8211; Charles Foix, Paris, France.<br \/>\n<\/span><span class=\"orcid\"><a href=\"https:\/\/orcid.org\/0000-0002-4098-277X\" target=\"_blank\" rel=\"noopener\">https:\/\/orcid.org\/0000-0002-4098-277X<\/a><\/span><\/li>\n<li><span class=\"name\"><strong>Christophe Jedrecy<\/strong><br \/>\n<\/span><span class=\"affiliation\">Urgences R\u00e9animation Centre Hospitalier Sud Essonnes CHSE, Paris, France.<\/span><\/li>\n<\/ul>\n<div class=\"item abstract\">\n<h3 class=\"label\">ABSTRACT<\/h3>\n<p>To date, there is no definite effective treatment for the COVID-19 pandemic. We performed an update network meta-analysis to compare and rank COVID-19 treatments according to their efficacy and safety. Literature search was performed from MEDLINE and CENTRAL databases from inception to September 5, 2020. Randomized clinical trials (RCTs) which compared the effect of any pharmacological drugs versus standard care or placebo 28-day after hospitalization in adult patients with COVID-19 disease were included. Risk ratio (RR) and 95% CI were calculated for 28-day all-cause mortality, clinical improvement, any adverse event (AEs), and viral clearance. A total of 25 RCTs, evaluating 17 different treatments, and 11,597 participants were analyzed. Remdesivir for 10-day compared to standard care (RR 0.69, 95% CI [0.48\u20130.99]), and a low dose compared to a high dose of HCQ (0.38, [0.17\u20130.89]) were associated with a lower risk of death. A total of 2,766 patients experienced clinical improvement, a 5-day course of remdesivir was associated with a higher frequency of clinical improvement compared to standard care (RR 1.21, 95% CI [1.00\u20131.47]). Compared to standard care, remdesivir for both 5 and 10 days, lopinavir\/ritonavir, and dexamethasone reduced the risk of any severe AEs by 52% (0.48, 0.34\u20130.67), 24% (0.77, 0.63\u20130.92), 40% (0.60, 0.37\u20130.98), and 50% (0.50, 0.25\u20130.98) respectively. In this study of hospitalized patients with COVID-19, administration of remdesivir for 10-day compared to standard care was associated with lower 28-day all-cause mortality and serious AEs, and higher clinical improvement rate.<\/p>\n<h3 class=\"label\">REFERENCES<\/h3>\n<div class=\"value\">\n<p>Johns Hopkins University [Internet]. Coronavirus Resource Center. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). Accessed 1 September 2020. 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Effect of convalescent plasma therapy on time to clinical improvement in patients with severe and life-threatening COVID-19: A randomized clinical trial. JAMA 2020;324:460-70. DOI:\u00a0<a href=\"https:\/\/doi.org\/10.1001\/jama.2020.10044\">https:\/\/doi.org\/10.1001\/jama.2020.10044<\/a><\/p>\n<p>Goldman JD, Lye DCB, Hui DS, et al. Remdesivir for 5 or 10 days in patients with severe Covid-19. N Engl J Med 2020;383:1827-37. DOI:\u00a0<a href=\"https:\/\/doi.org\/10.1056\/NEJMoa2015301\">https:\/\/doi.org\/10.1056\/NEJMoa2015301<\/a><\/p>\n<p>Tang W, Cao Z, Han M, et al. Hydroxychloroquine in patients with mainly mild to moderate coronavirus disease 2019: open label, randomised controlled trial. BMJ 2020;369:m1849. DOI:\u00a0<a href=\"https:\/\/doi.org\/10.1136\/bmj.m1849\">https:\/\/doi.org\/10.1136\/bmj.m1849<\/a><\/p>\n<p>Cao B, Wang Y, Wen D, et al. A trial of lopinavir\u2013ritonavir in adults hospitalized with severe Covid-19. N Engl J Med 2020;382:1787\u201199. DOI:\u00a0<a href=\"https:\/\/doi.org\/10.1056\/NEJMc2008043\">https:\/\/doi.org\/10.1056\/NEJMc2008043<\/a><\/p>\n<p>Wang Y, Zhang D, Du G, et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet 2020;395:1569\u201178.<\/p>\n<p>Borba MGS, Val FFA, Sampaio VS, et al. Effect of high vs low doses of chloroquine diphosphate as adjunctive therapy for patients hospitalized with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection: A randomized clinical trial. JAMA Netw Open 2020;3:e208857. DOI:\u00a0<a href=\"https:\/\/doi.org\/10.1001\/jamanetworkopen.2020.8857\">https:\/\/doi.org\/10.1001\/jamanetworkopen.2020.8857<\/a><\/p>\n<p>Hung IF-N, Lung K-C, Tso EY-K, et al. Triple combination of interferon beta-1b, lopinavir\u2013ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an open-label, randomised, phase 2 trial. Lancet 2020;395:1695\u2011704.<\/p>\n<p>Cavalcanti AB, Zampieri FG, Rosa RG, et al. Hydroxychloroquine with or without azithromycin in mild-to-moderate Covid-19. N Engl J Med 2020;383:e119. DOI:\u00a0<a href=\"https:\/\/doi.org\/10.1056\/NEJMx200021\">https:\/\/doi.org\/10.1056\/NEJMx200021<\/a><\/p>\n<p>Cao Y, Wei J, Zou L, et al. Ruxolitinib in treatment of severe coronavirus disease 2019 (COVID-19): A multicenter, single-blind, randomized controlled trial. J Allergy Clin Immunol 2020;146:137-46.e3. DOI:\u00a0<a href=\"https:\/\/doi.org\/10.1016\/j.jaci.2020.05.019\">https:\/\/doi.org\/10.1016\/j.jaci.2020.05.019<\/a><\/p>\n<p>Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the treatment of Covid-19 \u2014 Preliminary report. N Engl J Med 2020;383:992-4. DOI:\u00a0<a href=\"https:\/\/doi.org\/10.1056\/NEJMoa2007764\">https:\/\/doi.org\/10.1056\/NEJMoa2007764<\/a><\/p>\n<p>Spinner CD, Gottlieb RL, Criner GJ, et al. Effect of remdesivir vs standard care on clinical status at 11 days in patients with moderate COVID-19: A randomized clinical trial. JAMA 2020;324:1048-57. DOI:\u00a0<a href=\"https:\/\/doi.org\/10.1001\/jama.2020.16349\">https:\/\/doi.org\/10.1001\/jama.2020.16349<\/a><\/p>\n<p>Miller J, Bruen C, Schnaus M, et al. Auxora versus standard of care for the treatment of severe or critical COVID-19 pneumonia: results from a randomized controlled trial. Crit Care 2020;24:502. DOI:\u00a0<a href=\"https:\/\/doi.org\/10.1186\/s13054-020-03220-x\">https:\/\/doi.org\/10.1186\/s13054-020-03220-x<\/a><\/p>\n<p>Tomazini BM, Maia IS, Cavalcanti AB, et al. Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19: The CoDEX randomized clinical trial. JAMA 2020;324:1307-16. DOI:\u00a0<a href=\"https:\/\/doi.org\/10.1001\/jama.2020.17021\">https:\/\/doi.org\/10.1001\/jama.2020.17021<\/a><\/p>\n<p>The RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with Covid-19 &#8211; Preliminary report. N Engl J Med 2020;NEJMoa2021436.<\/p>\n<p>Dequin P-F, Heming N, Meziani F, et al. Effect of hydrocortisone on 21-day mortality or respiratory support among critically ill patients with COVID-19: A randomized clinical trial. JAMA 2020;324:1298-306. DOI:\u00a0<a href=\"https:\/\/doi.org\/10.1001\/jama.2020.16761\">https:\/\/doi.org\/10.1001\/jama.2020.16761<\/a><\/p>\n<p>The Writing Committee for the REMAP-CAP Investigators, Angus DC, Derde L, et al. Effect of hydrocortisone on mortality and organ support in patients with severe COVID-19: The REMAP-CAP COVID-19 corticosteroid domain randomized clinical trial. JAMA 2020;324:1317-29.<\/p>\n<p>Deftereos SG, Giannopoulos G, Vrachatis DA, et al. Effect of colchicine vs standard care on cardiac and inflammatory biomarkers and clinical outcomes in patients hospitalized with coronavirus disease 2019: The GRECCO-19 randomized clinical trial. JAMA Netw Open 2020;3:e2013136. DOI:\u00a0<a href=\"https:\/\/doi.org\/10.1001\/jamanetworkopen.2020.13136\">https:\/\/doi.org\/10.1001\/jamanetworkopen.2020.13136<\/a><\/p>\n<p>Arshad S, Kilgore P, Chaudhry ZS, et al. Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19. Int J Infect Dis 2020;97:396-403. DOI:\u00a0<a href=\"https:\/\/doi.org\/10.1016\/j.ijid.2020.06.099\">https:\/\/doi.org\/10.1016\/j.ijid.2020.06.099<\/a><\/p>\n<p>Rosenberg ES, Dufort EM, Udo T, et al. Association of treatment with hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID-19 in New York State. JAMA 2020;323:2493. DOI:\u00a0<a href=\"https:\/\/doi.org\/10.1001\/jama.2020.8630\">https:\/\/doi.org\/10.1001\/jama.2020.8630<\/a><\/p>\n<p>Mah\u00e9vas M, Tran V-T, Roumier M, et al. Clinical efficacy of hydroxychloroquine in patients with covid-19 pneumonia who require oxygen: observational comparative study using routine care data. BMJ 2020;369:m1844.<\/p>\n<p>Sbidian E, Josse J, Lemaitre G, et al. Hydroxychloroquine with or without azithromycin and in-hospital mortality or discharge in patients hospitalized for COVID-19 infection: a cohort study of 4,642 in-patients in France. medRxiv 2020. doi: 10.1101\/2020.06.16.20132597 DOI:\u00a0<a href=\"https:\/\/doi.org\/10.1101\/2020.06.16.20132597\">https:\/\/doi.org\/10.1101\/2020.06.16.20132597<\/a><\/p>\n<p>Lagier J-C, Million M, Gautret P, et al. Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine\/azithromycin and other regimens in Marseille, France: A retrospective analysis. Travel Med Infect Dis 2020;36:101791. DOI:\u00a0<a href=\"https:\/\/doi.org\/10.1016\/j.tmaid.2020.101791\">https:\/\/doi.org\/10.1016\/j.tmaid.2020.101791<\/a><\/p>\n<p>Cortegiani A, Ippolito M, Ingoglia G, et al. Update I. A systematic review on the efficacy and safety of chloroquine\/hydroxychloroquine for COVID-19. J Crit Care 2020;59:176-90. DOI:\u00a0<a href=\"https:\/\/doi.org\/10.1016\/j.jcrc.2020.06.019\">https:\/\/doi.org\/10.1016\/j.jcrc.2020.06.019<\/a><\/p>\n<p>Boulware DR, Pullen MF, Bangdiwala AS, et al. A randomized trial of hydroxychloroquine as postexposure prophylaxis for Covid-19. N Engl J Med 2020;383:517\u201125. DOI:\u00a0<a href=\"https:\/\/doi.org\/10.1056\/NEJMc2023617\">https:\/\/doi.org\/10.1056\/NEJMc2023617<\/a><\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>https:\/\/doi.org\/10.4081\/jphr.2021.1945 Alhassane Diallo INSERM, CIC 1411, CHU of Montpellier, St. Eloi Hospital, University of Montpellier, France. https:\/\/orcid.org\/0000-0002-1666-8641 Miguel Carlos-Bolumbu Urgences R\u00e9animation Centre Hospitalier Sud Essonnes CHSE, Paris, France. Marie Traor\u00e9 Service de Rhumatologie, APHP Henry Mondor, Paris, France. https:\/\/orcid.org\/0000-0003-2196-6720 Mamadou Hassimiou Diallo H\u00f4pitaux Universitaires Piti\u00e9 Salp\u00eatri\u00e8re &#8211; Charles Foix, Unit\u00e9 de Recherche Clinique Salp\u00eatri\u00e8re &#8211; &#8230; <a title=\"An updated systematic review and network meta-analysis of 25 randomized trials assessing the efficacy and safety of treatments in COVID-19 disease\" class=\"read-more\" href=\"https:\/\/www.jphres.us.com\/index.php\/jphres\/article\/view\/1945\/\" aria-label=\"More on An updated systematic review and network meta-analysis of 25 randomized trials assessing the efficacy and safety of treatments in COVID-19 disease\">Read more<\/a><\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-5808","page","type-page","status-publish"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>An updated systematic review and network meta-analysis of 25 randomized trials assessing the efficacy and safety of treatments in COVID-19 disease - Journal of Public Health Research<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.jphres.us.com\/index.php\/jphres\/article\/view\/1945\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"An updated systematic review and network meta-analysis of 25 randomized trials assessing the efficacy and safety of treatments in COVID-19 disease - Journal of Public Health Research\" \/>\n<meta property=\"og:description\" content=\"https:\/\/doi.org\/10.4081\/jphr.2021.1945 Alhassane Diallo INSERM, CIC 1411, CHU of Montpellier, St. Eloi Hospital, University of Montpellier, France. https:\/\/orcid.org\/0000-0002-1666-8641 Miguel Carlos-Bolumbu Urgences R\u00e9animation Centre Hospitalier Sud Essonnes CHSE, Paris, France. Marie Traor\u00e9 Service de Rhumatologie, APHP Henry Mondor, Paris, France. https:\/\/orcid.org\/0000-0003-2196-6720 Mamadou Hassimiou Diallo H\u00f4pitaux Universitaires Piti\u00e9 Salp\u00eatri\u00e8re &#8211; Charles Foix, Unit\u00e9 de Recherche Clinique Salp\u00eatri\u00e8re &#8211; ... 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Marie Traor\u00e9 Service de Rhumatologie, APHP Henry Mondor, Paris, France. https:\/\/orcid.org\/0000-0003-2196-6720 Mamadou Hassimiou Diallo H\u00f4pitaux Universitaires Piti\u00e9 Salp\u00eatri\u00e8re &#8211; Charles Foix, Unit\u00e9 de Recherche Clinique Salp\u00eatri\u00e8re &#8211; ... 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