减少COVID-19住院治疗的门诊随机对照试验:系统审查和元分析
David J Sullivan1, Daniele Focosi2, Daniel F Hanley3
1Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
单克隆抗体和康复期血显著减少了门诊患者的COVID-19住院治疗. 口服抗病毒药物是首选的,但对特定患者群体和资源设置来说,静脉注射选择仍然至关重要.
科学领域:
- 传染性疾病 传染性疾病
- 临床试验 临床试验
- 公共卫生 公共卫生
背景情况:
- 在各种干预措施,患者群体和流行病阶段,COVID-19治疗疗效各不相同.
- 了解门诊COVID-19治疗的比较有效性对于临床决策至关重要.
- 系统性审查和元分析对于合成随机对照试验 (RCT) 证据至关重要.
研究的目的:
- 系统地审查和比较四个主要的COVID-19门诊治疗类别的住院结果.
- 根据流行病时期,地理位置,病毒变异和疫苗状态来分析干预的有效性.
- 通过元分析提供各种门诊干预措施的近似对比比较.
主要方法:
- 系统审查门诊COVID-19随机对照试验 (RCT) 与住院终点,通过PubMed搜索确定到2023年5月.
- 排除30名参与者以下的RCT;从COVID-19-NMA中提取的偏差风险.
- 在干预类别中使用几率比率 (OR) 的比较:单克隆抗体 (mAbs),COVID-19康复性血 (CCP),小分子抗病毒药物和重用药物.
主要成果:
- 分析了涉及33项干预措施的61项已发表的RCT,来自281项已识别的研究,主要是针对患有住院风险因素的未接种疫苗的队列.
- 单克隆抗体 (OR=0.31) 在减少住院治疗方面表现出最高的疗效,其次是CCP (OR=0.69),小分子抗病毒药物 (OR=0.78) 和重定向药物 (OR=0.82).
- 在疾病发病早期进行的干预措施更有效;Omicron亚系 (XBB,BQ.1.1) 显示对mAbs.的耐药性.
结论:
- 如果有,建议口服抗病毒药物作为首选的门诊COVID-19治疗方法.
- 静脉干预措施,包括CCP和remdesivir,在资源有限的环境或免疫功能受损的个体中仍然有效和必要.
- 这一元分析提供了对门诊COVID-19干预措施的有价值的对比比较,尽管试验异质.
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