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Efficacy of pharmacological interventions in COVID‐19: A network meta‐analysis
Author(s) -
Selvarajan Sandhiya,
Anandaradje Annuja,
Shivabasappa Santhosh,
Melepurakkal Sadanandan Deepthy,
Nair N. Sreekumaran,
George Melvin
Publication year - 2022
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.15338
Subject(s) - covid-19 , meta analysis , psychological intervention , medicine , medline , intensive care medicine , pharmacology , virology , biology , psychiatry , disease , infectious disease (medical specialty) , biochemistry , outbreak
Aims To perform network meta‐analysis for a head‐to‐head comparison of various interventions used in coronavirus disease 2019 (COVID‐19) on mortality, clinical recovery, time to clinical improvement and the occurrence of serious adverse events. Methods Systematic search was performed using online databases with suitable MeSH terms including coronavirus, COVID‐19, randomized controlled trial, hydroxychloroquine, lopinavir/ritonavir, tocilizumab, remdesivir, favipiravir, dexamethasone and interferon‐β. Data were independently extracted by 2 study investigators and analysed. Results Out of 1225 studies screened, 23 were included for qualitative and quantitative analysis. Among the drugs studied, dexamethasone reduces mortality by 10%, with a relative risk of 0.90 (95% confidence interval [0.82–0.97]) and increases clinical recovery by 6% (relative risk 1.06, 95% confidence interval [1.02–1.10]) compared to standard of care. Similarly, remdesivir administered for 10 days increased clinical recovery by 10%, reduced time to clinical improvement by 4 days and lowered the occurrence of serious adverse events by 27% as compared to standard of care. Conclusion In comparison to standard of care, dexamethasone was found to increase clinical recovery and lower mortality; remdesivir was significantly associated with a lower risk of mortality as compared to tocilizumab and higher clinical recovery and shorter time to clinical improvement as compared to hydroxychloroquine and tocilizumab; remdesivir followed by tocilizumab were found to have lesser occurrence of serious adverse events in patients with moderate to severe COVID‐19.