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Published on: April 19, 2024
Evaluation of current medical approaches for COVID-19: a systematic review and meta-analysis
Meng Wang1,2,3, Ting Wu1,4,5, Zhihong Zuo1,2
1Department of Biochemistry and Molecular Biology, School of Life Sciences, Central South University, Changsha, Hunan 410013, China.
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.
Insights
Antiviral treatments for COVID-19 were evaluated, finding limited benefits for hydroxychloroquine, lopinavir/ritonavir, and Arbidol. Integrative Chinese-Western medicine improved symptoms, while remdesivir and convalescent plasma showed potential for severe cases.
Area of Science:
- Infectious Diseases
- Pharmacology
- Virology
Background:
- The urgent need for effective antiviral therapies for COVID-19 treatment persists due to the absence of widespread vaccination.
- This analysis reviews existing evidence on antiviral agents for COVID-19 management.
Purpose of the Study:
- To systematically evaluate the effectiveness and safety of various antiviral agents used in COVID-19 treatment.
- To identify potential therapeutic options for different stages and severities of COVID-19.
Main Methods:
- A comprehensive search of online databases was conducted for studies published up to June 22, 2020.
- Meta-analysis of 42 studies assessed the efficacy and safety of hydroxychloroquine, lopinavir/ritonavir, Arbidol, integrative Chinese-Western medicine, remdesivir, and convalescent plasma.
Main Results:
- Hydroxychloroquine showed no significant association with mortality or severe cases but was linked to adverse reactions and minimal viral RNA clearance benefits, though it shortened fever duration.
- Lopinavir/ritonavir and Arbidol did not demonstrate significant improvements in negative conversion rates.
- Integrative Chinese-Western medicine effectively alleviated clinical symptoms and reduced severe case incidence (RR=0.38).
- Remdesivir treatment was associated with reduced 14-day mortality in severe COVID-19 cases (RR=0.64).
- Convalescent plasma showed a trend towards increasing the negative conversion rate (RR=2.47).
Conclusions:
- Hydroxychloroquine, lopinavir/ritonavir, and Arbidol offer limited clinical benefits for COVID-19 treatment.
- Integrative Chinese-Western medicine shows promise in improving clinical symptoms.
- Remdesivir and convalescent plasma may be potential treatments for severe COVID-19.
- Further large-scale randomized controlled trials are necessary to confirm these findings.
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For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include: