Efficacy of various treatment modalities for nCOV‐2019: A systematic review and meta‐analysis

Misra, Shubham; Nath, Manabesh; Hadda, Vijay; Vibha, Deepti

doi:10.1111/eci.13383

Cited by 20 publications

(18 citation statements)

References 81 publications

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“…This finding is consistent with the results of previous meta-analyses reporting a reduction in mortality in COVID-19 patients treated with TCZ added to ST in comparison with those treated with ST alone [ 73 , 74 , 75 , 76 , 77 , 78 ].…”

Section: Discussionsupporting

confidence: 92%

Effect of Tocilizumab in Reducing the Mortality Rate in COVID-19 Patients: A Systematic Review with Meta-Analysis

Conti

Corbi

Sellitto

et al. 2021

JPM

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Data supporting the use of Tocilizumab (TCZ) in COVID-19 are contrasting and inconclusive. This meta-analysis aimed to assess TCZ effectiveness in reducing the mortality rate in COVID-19 patients. PubMed, Scopus, Embase, Cochrane, WILEY, and ClinicalTrials.gov were searched to evaluate observational studies and RCTs. The outcome was the mortality rate. Forty observational studies and seven RCTs, involving 9640 and 5556 subjects treated with Standard Therapy (ST) + TCZ or ST alone, respectively, were included. In patients treated with ST+TCZ, a higher survival (Log odds ratio = −0.41; 95% CI: −0.68 −0.14; p < 0.001) was found. Subgroups analyses were performed to better identify the possible interference of some parameters in modifying the efficacy of TCZ therapy on COVID-19 mortality. Separating observational from RCTs, no statistically significant (p = 0.70) TCZ-related reduction of mortality regarding RCTs was found, while a significant reduction (Log odds ratio = −0.52; 95% CI: −0.82 −0.22, p < 0.001) was achieved regarding the observational studies. Stratifying for the use of Invasive Mechanic Ventilation (IMV), a higher survival was found in patients treated with TCZ in the No-IMV and IMV groups (both p < 0.001), but not in the No-IMV/IMV group. Meta-regression analyses were also performed. The meta-analysis of observational studies reveals that TCZ is associated with reducing the mortality rate in both severe and critically ill patients. Although the largest RCT, RECOVERY, is in line with this result, the meta-analysis of RCTs failed to found any difference between ST + TCZ and ST. It is crucial to personalize the therapy considering the patients’ characteristics.

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Section: Discussionsupporting

confidence: 92%

Effect of Tocilizumab in Reducing the Mortality Rate in COVID-19 Patients: A Systematic Review with Meta-Analysis

Conti

Corbi

Sellitto

et al. 2021

JPM

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“…In another RCT on severe COVID-19, the 28-day mortality rate did not differ between remdesivir-treated patients and controls 21 ( Table 3 ). According to a meta-analysis for these two RCTs 20 , 21 , the RR for clinical recovery was 1.17 (95% CI 1.07 to 1.29) 22 ( Table 4 ).…”

Section: Resultsmentioning

confidence: 99%

“…In the aforementioned RCT on COVID-19 comparing a combination of lopinavir/ritonavir and umifenovir with standard treatment 34 , and in another RCT on COVID-19 comparing “lopinavir/ritonavir plus IFN-α with or without ribavirin” with “ribavirin plus IFN-α” 41 , treatment with lopinavir/ritonavir did not show superior outcomes in terms of clinical deterioration or viral clearance ( Table 3 ). In meta-analyses on COVID-19 involving two of these RCTs 34 , 40 , treatment with lopinavir/ritonavir was not associated with clinical recovery or viral clearance 22 , 42 , 43 ( Table 4 ).…”

Section: Resultsmentioning

confidence: 99%

Treatment of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and coronavirus disease 2019 (COVID-19): a systematic review of in vitro, in vivo, and clinical trials

Lee¹,

Yoon²,

Nam³

et al. 2021

Theranostics

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Rationale: Coronavirus disease 2019 (COVID-19) has spread worldwide and poses a threat to humanity. However, no specific therapy has been established for this disease yet. We conducted a systematic review to highlight therapeutic agents that might be effective in treating COVID-19. Methods: We searched Medline, Medrxiv.org, and reference lists of relevant publications to identify articles of in vitro , in vivo , and clinical studies on treatments for severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and COVID-19 published in English until the last update on October 11, 2020. Results: We included 36 studies on SARS, 30 studies on MERS, and 10 meta-analyses on SARS and MERS in this study. Through 12,200 title and 830 full-text screenings for COVID-19, eight in vitro studies, 46 randomized controlled trials (RCTs) on 6,886 patients, and 29 meta-analyses were obtained and investigated. There was no therapeutic agent that consistently resulted in positive outcomes across SARS, MERS, and COVID-19. Remdesivir showed a therapeutic effect for COVID-19 in two RCTs involving the largest number of total participants (n = 1,461). Other therapies that showed an effect in at least two RCTs for COVID-19 were sofosbuvir/daclatasvir (n = 114), colchicine (n = 140), IFN-β1b (n = 193), and convalescent plasma therapy (n = 126). Conclusions: This review provides information to help establish treatment and research directions for COVID-19 based on currently available evidence. Further RCTs are required.

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“…However, a recent study at a large medical center in New York City that examined the association between hydroxychloroquine use and intubation or death of patients with Covid-19, revealed that hydroxychloroquine administration was not associated with either a greatly lowered or an increased risk of the composite end-point of intubation or death [ 99 ]. However, most recent meta-analysis studies demonstrated that hydroxychloroquine administration might cause harm in COVID-19 patients [ 100 , 101 ].…”

Section: Treatmentmentioning

confidence: 99%

Renal Manifestations of Covid-19: Physiology and Pathophysiology

Armaly

Kinaneh

Skorecki

2021

JCM

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Corona virus disease 2019 (COVID-19) imposes a serious public health pandemic affecting the whole world, as it is spreading exponentially. Besides its high infectivity, SARS-CoV-2 causes multiple serious derangements, where the most prominent is severe acute respiratory syndrome as well as multiple organ dysfunction including heart and kidney injury. While the deleterious impact of SARS-CoV-2 on pulmonary and cardiac systems have attracted remarkable attention, the adverse effects of this virus on the renal system is still underestimated. Kidney susceptibility to SARS-CoV-2 infection is determined by the presence of angiotensin-converting enzyme 2 (ACE2) receptor which is used as port of the viral entry into targeted cells, tissue tropism, pathogenicity and subsequent viral replication. The SARS-CoV-2 cellular entry receptor, ACE2, is widely expressed in proximal epithelial cells, vascular endothelial and smooth muscle cells and podocytes, where it supports kidney integrity and function via the enzymatic production of Angiotensin 1-7 (Ang 1-7), which exerts vasodilatory, anti-inflammatory, antifibrotic and diuretic/natriuretic actions via activation of the Mas receptor axis. Loss of this activity constitutes the potential basis for the renal damage that occurs in COVID-19 patients. Indeed, several studies in a small sample of COVID-19 patients revealed relatively high incidence of acute kidney injury (AKI) among them. Although SARS-CoV-1 -induced AKI was attributed to multiorgan failure and cytokine release syndrome, as the virus was not detectable in the renal tissue of infected patients, SARS-CoV-2 antigens were detected in kidney tubules, suggesting that SARS-CoV-2 infects the human kidney directly, and eventually induces AKI characterized with high morbidity and mortality. The mechanisms underlying this phenomenon are largely unknown. However, the fact that ACE2 plays a crucial role against renal injury, the deprivation of the kidney of this advantageous enzyme, along with local viral replication, probably plays a central role. The current review focuses on the critical role of ACE2 in renal physiology, its involvement in the development of kidney injury during SARS-CoV-2 infection, renal manifestations and therapeutic options. The latter includes exogenous administration of Ang (1-7) as an appealing option, given the high incidence of AKI in this ACE2-depleted disorder, and the benefits of ACE2/Ang1-7 including vasodilation, diuresis, natriuresis, attenuation of inflammation, oxidative stress, cell proliferation, apoptosis and coagulation.

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Efficacy of various treatment modalities for nCOV‐2019: A systematic review and meta‐analysis

Cited by 20 publications

References 81 publications

Effect of Tocilizumab in Reducing the Mortality Rate in COVID-19 Patients: A Systematic Review with Meta-Analysis

Effect of Tocilizumab in Reducing the Mortality Rate in COVID-19 Patients: A Systematic Review with Meta-Analysis

Treatment of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and coronavirus disease 2019 (COVID-19): a systematic review of in vitro, in vivo, and clinical trials

Renal Manifestations of Covid-19: Physiology and Pathophysiology

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