A complementary critical appraisal on systematic reviews regarding the most efficient therapeutic strategies for the current COVID‐19 (SARS‐CoV‐2) pandemic

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.

Protecting older patients with cardiovascular diseases from COVID-19 complications using current medications

“…ACE2 is a receptor present in many tissues throughout the human body, with a remarkable expression in the lungs type II pneumocytes, and it is important in the control of antiatherosclerosis processes and blood pressure [6]. ACE2 is an aminopeptidase that converts Angiotensin (Ang) II into Ang [1][2][3][4][5][6][7]. Ang II exerts powerful vasoconstrictor, pro-fibrotic, and pro-inflammatory effects through AT1 receptors.…”

“…Indeed, subsequent systematic reviews and a recent RCT [14] support this recommendation [15,16]. Moreover, the infusion of the soluble isoform of ACE2 is being studied as a decoy receptor for SARS-CoV-2 particles, reducing infectivity and conserving cardioprotective actions via Ang [1][2][3][4][5][6][7][8].…”

“…Ang II exerts powerful vasoconstrictor, pro-fibrotic, and pro-inflammatory effects through AT1 receptors. In contrast, Ang [ 1 – 7 ] is a potent vasodilator, anti-apoptotic, and anti-proliferative agent through Mas receptors. SARS-CoV-2 uses the ACE2 as a cellular receptor to entry the host cells [ 7 ].…”

“…There is increasing knowledge of the potential benefits of steroids and specific antiviral treatments (e.g., remdesivir) in COVID-19 [ 1 ] and vaccination programs have commenced globally at end of 2020. However, the outcome of viral infection does not hinge only on the specific effects of the invading pathogen, but it also depends on the host response and premorbid condition.…”

Evaluation of the consistency of RT-PCR test results in nasopharyngeal and fecal specimens in patients with Covid-19 disease with gastrointestinal symptoms

“…The disease has since spread around the world, leading to a persistent pandemic. The clinical spectrum of COVID-19 varies from asymptomatic or mild respiratory problems to severe pneumonia and respiratory distress syndrome (1)(2)(3). Most patients infected with COVID-19 show symptoms of fever, cough, myalgia, fatigue, and shortness of breath.…”