Systematic Review
Volume 4 Issue 12 - 2020
A Contemporary Systematic Review of Systematic Reviews on the Safety and Efficacy of the Pharmacological Treatments of COVID-19
Shafi U Bhuhiyan1,2*, Housne A Begum2,3, Salma M Amarin2, Sanchit Kharwal2, Shaimaa M Kandil2, Sumra Latif2 and Yasmine M Shalaby2
1University of Toronto, Toronto, ON, Canada
2Ryerson University, Toronto, ON, Canada
3McMaster University, Hamilton, ON, Canada
*Corresponding Author: Shafi U Bhuiyan, University of Toronto and Ryerson University, Toronto, ON, Canada.
Received: October 14, 2020; Published: November 27,, 2020




Abstract

Introduction: The 2019 Coronavirus infection caused by Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) has emerged as a significant public health emergency worldwide. The World Health Organization declared the outbreak as a pandemic on March 11th, 2020 and by September 16th, 2020, it had infected more than 29.6 million people and more than 936,000 deaths across nations. Many pharmacological drugs have been used to treat patients with COVID 19, including antimalarial, antivirals, monoclonal antibodies and corticosteroids, but the evidence of these therapeutics' safety efficacy remains unclear.

Objective: To systematically assess and compile the existing evidence from systematic reviews on existing pharmacological treatments' safety and efficacy for COVID-19 regarding mortality and RT-PCR conversion.

Methods: We conducted a comprehensive search of literature published in PubMed articles on systematic reviews of COVID-19 pharmacological treatments within the last one year as of July 25th, 2020. The quality of systematic reviews was performed by following AMSTAR-2.

Results: We identified 558 articles. After appropriate exclusion based on title and abstract, a full review was performed on 27 articles. A total of 9 systematic reviews were included in this article with a total population of 45101 patients; only 4 of them included meta-analysis. There were 6 systematic reviews with a moderate risk of bias, and only 3 reviews had a low risk of bias. The results of compiled reviews showed that the treatment of COVID-19 patients with CQ/HCQ had no benefit on viral clearance or decreased risk of death than standard care. Moreover, high dose CQ/HCQ regimens or combination with macrolides may induce harm by increasing the risk of prolonged QTc interval and ventricular arrhythmias. Evidence from RCTs showed no statistically significant difference in mortality rate between patients treated with lopinavir-ritonavir (LPV/r) or those receiving standard care or other antiviral drugs. The umifenovir showed good safety and tolerability but limited efficacy. Based on low-quality evidence, tocilizumab treatment lowered the mortality rate among treated patients compared to the control group, but this difference was not statistically significant. Moreover, the use of tocilizumab was associated with an increased risk for secondary infection. Meanwhile, the results of clinical studies on the role of corticosteroids in treatment of patients with COVID- 19 remain controversial.

Conclusion: To the authors' knowledge, this is the first systematic review of systematic reviews related to pharmacological medications used to treat patients with COVID-19. The existing evidence from systematic reviews on the safety and efficacy of the above-mentioned pharmacological treatments for COVID-19 remains insufficient. Most reviews had several limitations in the included studies such as: lack of an insufficient number of RCTs, combining evidence from RCT and non-RCT studies, heterogeneity in patient characteristics, measured outcomes and dosage of treatment regimens. High-quality evidence from RCTs is needed to provide more reliable insight on those therapeutics' efficacy and safety as a treatment option of current and future coronaviruses epidemics.

Keywords:COVID-19; SARS-COV 2; Treatment; Pharmacological; Efficacy; Safety

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Citation: Shafi U Bhuhiyan.,et al. “A Contemporary Systematic Review of Systematic Reviews on the Safety and Efficacy of the Pharmacological Treatments of COVID-19”. EC Emergency Medicine and Critical Care 4.12 (2020): 58-73.

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