Systematic review and meta-analysis of effectiveness of treatment options against SARS-CoV-2 infection

Abstract

Treatment options for severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) are limited with no clarity on efficacy and safety profiles. We performed a systematic review and meta-analysis of studies on patients ≥18 years reporting data on therapeutic interventions in SARS-CoV-2. Primary outcome was all-cause mortality and secondary outcomes were rates of mechanical ventilation, viral clearance, adverse events, discharge, and progression to severe disease. Pooled rates and odds ratios (OR) were calculated. Twenty-nine studies with 5207 patients were included. Pooled all-cause mortality in intervention arm was 12.8% (95% confidence interval [CI]: 8.1%-17.4%). Mortality was significantly higher for studies using hydroxychloroquine (HCQ) for intervention (OR: 1.36; 95% CI: 0.97-1.89). Adverse events were also higher in HCQ subgroup (OR: 3.88; 95% CI: 1.60-9.45). There was no difference in other secondary outcomes. There is a need for well-designed randomized clinical trials for further investigation of every therapeutic intervention for further insight into different therapeutic options.

Keywords: COVID-19; HCQ; SARS-CoV-2; hydroxychloroquine; meta-analysis.

Figure 1

PRISMA Flow diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta‐Analyses

Figure 2

A, Odds ratio comparing all‐cause in hospital mortality in intervention and control arms. B, Odds ratio comparing all‐cause in hospital mortality in intervention and control arms in hydroxychloroquine based studies

Figure 3

A, Odds ratio comparing rates of mechanical ventilation in intervention and control arms. B, Odds ratio comparing clinical recovery rates in intervention and control arms

Figure 4

A, Odds ratio comparing adverse events rates in intervention and control arms. B, Odds ratio comparing adverse events in intervention and control arms in HCQ based studies. HCQ, hydroxychloroquine