Abstract
Background: This critical appraisal aims to clarify which systematic reviews on COVID-19 treatment are based on high-value evidence. Hereby, the most profitable medicines can be suggested.
Methods: The mesh terms of “COVID-19 drug treatment” (Supplementary Concept) and “COVID-19 drug treatment” were sequentially utilized as search strategies in Medline and Science direct on October 18, 2020. Searches were confined to systematic reviews/meta-analyses. The Cochrane database was searched on November 1, 2020 with “COVID.” With adding up four articles from other resources, 84 systematic reviews were considered for initial screening. Finally, 22 articles fulfilled the criteria and were assessed using PRISMA guidelines.
Results: Increasing number of clinical trials from the onset of the COVID-19 pandemic has revealed that hydroxychloroquine and chloroquine are not only profitable but also deleterious. Lopinavir/ritonavir failed to maintain their initial efficacy in improving clinical symptoms and mortality rate. Steroids and tocilizumab were suggested in patients with intensely severe symptoms. Steroids reduced mechanical ventilation and death in severely ill patients. Plasma or immunoglobulins effects are absolutely controversial. Favorable impressions of remdesivir have been relied on for the early onset of this drug. Hypotension and abnormal liver function tests were realized as its side effects. Favipiravir has resulted in a higher viral clearance than remdesivir. However, this claim needs to be proved with subsequent clinical trials.
Conclusions: Currently, remdesivir and favipiravir are advantageous drugs that should be administered in the early phases. Their side effects are not well known and need to be found in the following research projects. Steroids and tocilizumab have been considered beneficial in the cytokine storm phase.
Keywords: COVID-19; Coronavirus; pandemic; treatment.
【저자키워드】 COVID-19, Treatment, coronavirus, pandemic, 【초록키워드】 Treatment, Efficacy, clinical trial, Chloroquine, Lopinavir/ritonavir, Hydroxychloroquine, Clinical symptoms, mechanical ventilation, Tocilizumab, COVID-19 drug treatment, COVID-19 pandemic, immunoglobulins, Lopinavir, Ritonavir, Remdesivir, Favipiravir, clinical trials, systematic review, drug, database, Steroids, viral clearance, COVID-19 treatment, Medicine, Immunoglobulin, Hypotension, Research, Patient, death, plasma, drug treatment, mortality rate, Side effects, critical appraisal, Evidence, meta-analyses, Deleterious, systematic reviews, criteria, steroid, Liver function test, Side effect, clinical symptom, severe symptoms, initial screening, Science Direct, article, severely ill patients, Administered, concept, Effect, resources, mesh terms, initial, subsequent, reduced, searched, suggested, maintain, Increasing, the cytokine storm, were assessed, 【제목키워드】 SARS-CoV-2, systematic review, critical appraisal, therapeutic strategy, complementary,