Clinical effectiveness of drugs in hospitalized patients with COVID-19: a systematic review and meta-analysis

Abstract

The aim was to assess the clinical effectiveness of drugs used in hospitalized patients with COVID-19 infection. We conducted a systematic review of randomized clinical trials assessing treatment with remdesivir, chloroquine, hydroxychloroquine, lopinavir, ritonavir, dexamethasone, and convalescent plasma, for hospitalized patients with a diagnosis of SARS-CoV-2 infection. The outcomes were mortality, clinical improvement, duration of ventilation, duration of oxygen support, duration of hospitalization, virological clearance, and severe adverse events. A total of 48 studies were retrieved from the databases. Eleven articles were finally included in the data extraction and qualitative synthesis of results. The meta-analysis suggests a benefit of dexamethasone versus standard care in the reduction of risk of mortality at day 28; and the clinical improvement at days 14 and 28 in patients treated with remdesivir. We can conclude that dexamethasone would have a better result in hospitalized patients, especially in low-resources settings. The analysis of the main treatments proposed for hospitalized patients is of vital importance to reduce mortality in low-income countries, since the COVID-19 pandemic had an economic impact worldwide with the loss of jobs and economic decline in countries with scarce resources.The reviews of this paper are available via the supplemental material section.

Keywords: COVID-19; SARS-CoV-2; antivirals; clinical improvement; drugs; mortality.

Figure 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart of the inclusion process in the systematic review.

Figure 2.

Forest plot of drugs employed in hospitalized patients with SARS-CoV-2 infection. Comparison: dexamethasone versus standard care. Outcome: mortality at day 28. CI, confidence interval; IV, inverse variance.

Figure 3.

Forest plot of drugs employed in hospitalized patients with SARS-CoV-2 infection. Comparison: remdesivir versus standard care or placebo. Outcome: clinical improvement. CI, confidence interval; IV, inverse variance.