Pharmacological interventions to prevent Covid-19 disease: A rapid review

Area of Science:

• Pharmacology
• Infectious Diseases
• Evidence-Based Medicine

Background:

• Coronavirus disease 2019 (COVID-19) poses a significant global health challenge.
• Effective pharmacological interventions are crucial for prevention and treatment, excluding vaccines.
• Rapid assessment of emerging evidence is vital for clinical decision-making.

Purpose of the Study:

• To evaluate the effectiveness of pharmacological interventions (excluding vaccines) in preventing COVID-19.
• To assess the efficacy of these interventions in reducing COVID-19 disease severity.
• To synthesize evidence from randomized controlled trials and other study designs.

Main Methods:

• Systematic literature search of peer-reviewed articles and pre-prints from January 2020 to August 2021.
• Inclusion of randomized controlled trials (RCTs) and non-RCTs evaluating pharmacological agents.
• Assessment of risk of bias and certainty of evidence for included studies.

Main Results:

• Three trials (two RCTs, one non-RCT) tested ivermectin; all suggested potential benefit but had high risk of bias and 'very low' certainty of evidence.
• One RCT on bamlanivimab showed reduced COVID-19 incidence (low risk of bias, 'very low' certainty of evidence).
• One RCT on casirivimab plus imdevimab demonstrated significant reductions in infection incidence, viral load, and disease duration (low risk of bias, 'low' certainty of evidence).

Conclusions:

• The certainty of evidence for most pharmacological interventions, including ivermectin and bamlanivimab, is 'very low', indicating uncertain estimates of effect.
• Monoclonal antibodies (casirivimab plus imdevimab) showed promise but with 'low' certainty of evidence.
• Currently, there is insufficient high-quality evidence to support the use of pharmacological interventions for preventing COVID-19.