Indian studies performed a meta-analysis of drug use in COVID-19. Scientists evaluate clinical mortality, progression, time to clinical manifestation, and exclusion of serious diseases.
The meta-analysis included 23 randomized trials involving 31,226 hospitalized patients with deceased and severe COVID-19. The average age of participants is from 40 to 69 years. 37.5% are women.
For the treatment of standard care or drug patients:
- hydroxychloroquine;
- lopinavir/ritonavir;
- tocilizumab;
- remdesivir;
- favipiravir;
- dexamethasone;
- interferon-beta.
Standard care is provided depending on the region of study.
Hydroxychloroquine is an antimalarial drug shown in laboratory studies to cause a morbidity reaction. Recently, however, Dutch studies have found that hydroxychloroquine suppresses the innate immune response and generally trained immunity and may harm COVID-19.
Lopinavir and ritonavir are repurposed antiretroviral drugs that block the replication of the human immunodeficiency virus and are used to treat HIV.
Tocilizumab suppresses the activity of the immune system and is used to treat rheumatoid arthritis. Introduction of tocilizumab into mechanical ventilation in patients with the removal of COVID-19.
Remdesivir is an antiviral drug that inhibits viral replication. Remdesivir is used to treat previous coronaviruses: SARS-CoV-1 and MERS. In SARS-CoV-2, remdesivir accelerated recovery. The Infectious Diseases Society of America uses remdesivir in hospitalized patients with COVID-19 who require supplemental oxygen, mechanical ventilation, or extracorporeal membrane oxygenation. The World Health Organization recommends using remdesivir in moderate to severe COVID-19 patients at high risk of hospitalization.
Favipiravir is an antiviral drug used in Japan for treatment. In coronavirus, favipiravir significantly improves the clinical and radiological picture compared with conventional therapy but does not affect viral clearance and the need for oxygen support.
Dexamethasone is a glucocorticoid that reduces the activity of the immune system and eliminates inflammation. Dexamethasone reduced mortality in patients with severe COVID-19.
Interferon-beta activates the antiviral defense of the body. Early administration of interferon-beta in COVID-19 reduced mortality and the need for intensive care and artificial lung ventilation, accelerated recovery.
Meta-Analysis Results
Mortality:
- Dexamethasone reduced mortality by 10% compared to standard treatment.
- Dexamethasone and remdesivir were associated with a lower risk of death than hydroxychloroquine.
- Remdesivir was associated with a lower risk of death compared to tocilizumab.
Clinical recovery:
- Remdesivir, prescribed for 10 days, increased clinical recovery by 10% compared to standard treatment.
- Dexamethasone increased clinical recovery by 6% compared to standard treatment.
- Remdesivir, prescribed for 10 and 5 days, reduced the time to clinical improvement by 4.08 and 3.98 days, respectively, compared with standard treatment.
- Remdesivir increased clinical recovery and was associated with a shorter time to clinical improvement compared to hydroxychloroquine and tocilizumab.
Side effects:
- Remdesivir and tocilizumab administered within 10 days were associated with a lower prevalence of serious adverse events than the standard treatment.
The effect of the other drugs was insignificant.
Which drugs are superior to other methods of treatment:
- Remdesivir administered for 10 days, followed by dexamethasone, is more likely to reduce mortality.
- Remdesivir, prescribed for 10 days, is more likely to increase clinical recovery.
- The combination of lopinavir/ritonavir with a probability of 79% ranks first in the least number of serious adverse events. The second and third places are occupied by dexamethasone and remdesivir, prescribed within 10 days.
Conclusions
Dexamethasone reduced mortality in COVID-19 by 10% and increased clinical recovery by 6%. Remdesivir, prescribed for 10 days, increased clinical recovery by 10% and accelerated clinical improvement by 4 days.
The combination of lopinavir and ritonavir, interferon-beta, tocilizumab and hydroxychloroquine did not reduce mortality in COVID-19. Favipiravir, tocilizumab and hydroxychloroquine did not increase clinical recovery.
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Reference
Efficacy of pharmacological interventions in COVID-19: A network meta-analysis
