Pharmacological interventions to prevent Covid‐19 disease: A rapid review

Abstract

Summary The aim of this rapid review was to determine the effectiveness of pharmacological interventions (excluding vaccines) to prevent coronavirus disease 2019 (Covid‐19) or reduce the severity of disease. A systematic search of published peer‐reviewed articles and non‐peer‐reviewed pre‐prints was undertaken from 1 January 2020 to 17 August 2021. Four randomised controlled trials (RCTs) and one non‐RCT were included; three trials (two RCTs and one non‐RCT) tested ivermectin with or without carrageenan. While all reported some potential protective effect of ivermectin, these trials had a high risk of bias and the certainty of evidence was deemed to be ‘very low’. One RCT tested bamlanivimab compared to placebo and reported a significantly reduced incidence of Covid‐19 in the intervention group; this trial had a low risk of bias however the certainty of evidence was deemed ‘very low’. The fifth RCT tested casirivimab plus imdevimab versus placebo and reported that the combination of monoclonal antibodies significantly reduced the incidence of symptomatic and asymptomatic SARS‐CoV‐2 infection, viral load, duration of symptomatic disease and the duration of a high viral load; this trial was deemed to have a low risk of bias, and the certainty of evidence was ‘low’. The designations ‘low' and ‘very low’ regarding the certainty of evidence indicate that the estimate of effect is uncertain and therefore is unsuitable for informing decision‐making. At the time of writing, there is insufficient high quality evidence to support the use of pharmacological interventions to prevent Covid‐19.

Rapid reviews methods series: assessing the appropriateness of conducting a rapid review

“…Urgent decision-making: RRs are valuable when policy-makers, healthcare providers or public health authorities face urgent decisions, such as responding to disease outbreaks, natural disasters or emerging health threats and need evidence to inform immediate actions 33 34. RRs can also guide clinical care decisions by synthesising available evidence for healthcare professionals requiring evidence for time-sensitive direct patient care decisions 35 36…”

Current and emerging immunomodulators for treatment of SARS-CoV2 infection (COVID-19)

“…Ivermectin reduces the production of tumor necrosis factor (TNF)-alpha, IL-1 and IL-6 and numerous non-randomized, underpowered studies have demonstrated clinical efficacy in small studies [ 56 ]. However, the optimal dose, duration, and treatment population have not yet been identified and further studies are ongoing and it is not currently recommended as a treatment for COVID-19.…”

Knowledge, Attitudes and Practices of the General Population in Yemen Regarding COVID-19: A Cross-Sectional Study

“…Standard preventive procedures including social distancing, regular hand sanitization, regular wiping of surfaces, quarantining and wearing of face masks have been adopted worldwide as the most effective methods of reducing the spread of the virus and limiting its morbidity and mortality [ 13 , 14 , 15 , 16 , 17 ]. While many treatments have been suggested to treat patients with COVID-19, only a few pharmacological therapies have been shown to be beneficial in the management of COVID-19 [ 18 , 19 , 20 , 21 , 22 ]. Therefore, many governments and health authorities, including the WHO, have been actively educating people to take preventive measures to decrease the spread of the virus [ 23 , 24 , 25 , 26 ].…”