The impact of therapeutics on mortality in hospitalised patients with COVID-19: systematic review and meta-analyses informing the European Respiratory Society living guideline

Abstract

Hospitalised patients with coronavirus disease 2019 (COVID-19) have a high mortality rate. There are an increasing number of published randomised controlled trials for anti-inflammatory, anti-viral and other treatments. The European Respiratory Society Living Guidelines for the Management of Hospitalised Adults with COVID-19 were published recently, providing recommendations on appropriate pharmacotherapy.Patient, Intervention, Comparator and Outcomes questions for key interventions were identified by an international panel and systematic reviews were conducted to identify randomised controlled trials meeting the inclusion criteria. The importance of end-points were rated, and mortality was identified as the key “critical” outcome for all interventions. Random-effects meta-analysis was used to pool studies and provide effect estimates for the impact of treatments on mortality.Corticosteroids, hydroxychloroquine, azithromycin, remdesivir, anti-interleukin (IL)-6 monoclonal antibodies, colchicine, lopinavir/ritonavir and interferon-β have been reviewed.Our results found further evidence in support of the use of corticosteroids, particularly dexamethasone, and anti-IL-6 receptor monoclonal antibody therapy. These data support the need to identify additional therapies with beneficial effects on mortality.

Special Considerations for Paxlovid Treatment Among Transplant Recipients With SARS-CoV-2 Infection

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High-cited favorable studies for COVID-19 treatments ineffective in large trials

“…Remdesivir is probably the most notable example in this regard. It is not recommended by the European Respiratory Society 62 and the World Health Organization has issued a conditional recommendation against its use. 63 Conversely, the US National Institutes of Health (NIH) list remdesivir very prominently among the very few treatments that they recommend.…”

Update June 2022: management of hospitalised adults with coronavirus disease 2019 (COVID-19): a European Respiratory Society living guideline

“…[43][44][45] Following completion of our systematic review the RECOVERY trial published data on a further 8156 patients randomized to baricitinib or usual care, demonstrating a significant reduction in mortality age-adjusted rate ratio of 0.87 95%CI 0.77-0.98. 46 A meta-analysis incorporating these data supported a 20% reduction in mortality. Importantly, 95-96% of patients were receiving corticosteroids and 23% were receiving tocilizumab in RECOVERY and the efficacy and safety of baricitinib was not affected by co-administration with tocilizumab.…”