Navigating Therapeutic Frontiers: A Meta-review and Meta-analysis of COVID-19 Treatment Options

To assess the efficacy and safety of each therapeutic options in the treatment of COVID-19 by assessing the evidence from existing systematic reviews and meta-analyses, and to carry out an umbrella meta-analysis of all meta-analysis studies to assess the efficacy of each drug. A comprehensive search was carried out in electronic databases for systematic reviews and meta-analyses which compared the efficacy and/or safety of therapeutic options in the treatment of COVID-19. Findings from the reviews were synthesized using tables and forest plots and the pooled estimate of effect size using the DerSimonian and Laird method was used for the updated meta-analysis. The main outcome was mortality. 285 reviews with 152 meta-analyses were included, The analysis of systematic reviews contents indicated that most reviewed drugs were as follows: chroquine/hydroxychloroquine (n = 48), tocilizumab (n = 39), remdesivir (n = 25), corticosteroids (n = 25), JAK inhibitors (n = 12), colchicine (n = 11), ivermectin (n = 8), anakinra (n = 7), favipravir (n = 7), lopinavir/ritonavir (n = 6), ACEI/ARB (n = 6), azithromycin (n = 4), sofosbuvir (n = 4), and Vitamin D (n = 4). Findings from the included reviews suggested that tocilizumab, remdesivir, corticosteroids, JAKI, anakinra, colchicine, ivermectin, and sofosbuvir decreased the rate of mortality significantly in those taking the drugs; otherwise hydroxylchroquine increased the risk of mortality significantly, while Lopinavir/Ritonavir had no benefit and ACEI and azithromycin decreased mortality rate not significantly. lower requirement for mechanical ventilation and intensive care unit admission and a shorter hospital length of stay was observed with the tocilizumab, JAKIs, anakinra, corticosteroids and sofosbuvir Only one third of the included reviews had 70% quality based on the AMSTAR scale assessment. The results of this study have the potential to be a useful tool for the translation of health evidence and for designing the decision support systems for evidence synthesis.