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Meta-Analysis
. 2021 Dec 15;30(162):210171.
doi: 10.1183/16000617.0171-2021. Print 2021 Dec 31.

The impact of therapeutics on mortality in hospitalised patients with COVID-19: systematic review and meta-analyses informing the European Respiratory Society living guideline

Megan L Crichton  1 , Pieter C Goeminne  2 , Krizia Tuand  3 , Thomas Vandendriessche  3 , Thomy Tonia  4 , Nicolas Roche  5 , James D Chalmers  6 ; European Respiratory Society COVID-19 Task Force
Affiliations
Meta-Analysis

The impact of therapeutics on mortality in hospitalised patients with COVID-19: systematic review and meta-analyses informing the European Respiratory Society living guideline

Megan L Crichton et al. Eur Respir Rev. .

Abstract

Hospitalised patients with coronavirus disease 2019 (COVID-19) have a high mortality rate. There are an increasing number of published randomised controlled trials for anti-inflammatory, anti-viral and other treatments. The European Respiratory Society Living Guidelines for the Management of Hospitalised Adults with COVID-19 were published recently, providing recommendations on appropriate pharmacotherapy.Patient, Intervention, Comparator and Outcomes questions for key interventions were identified by an international panel and systematic reviews were conducted to identify randomised controlled trials meeting the inclusion criteria. The importance of end-points were rated, and mortality was identified as the key "critical" outcome for all interventions. Random-effects meta-analysis was used to pool studies and provide effect estimates for the impact of treatments on mortality.Corticosteroids, hydroxychloroquine, azithromycin, remdesivir, anti-interleukin (IL)-6 monoclonal antibodies, colchicine, lopinavir/ritonavir and interferon-β have been reviewed.Our results found further evidence in support of the use of corticosteroids, particularly dexamethasone, and anti-IL-6 receptor monoclonal antibody therapy. These data support the need to identify additional therapies with beneficial effects on mortality.

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Conflict of interest statement

Conflict of interest: M.L. Crichton has nothing to disclose. Conflict of interest: P.C. Goeminne has nothing to disclose. Conflict of interest: K. Tuand has nothing to disclose. Conflict of interest: T. Vandendriessche has nothing to disclose. Conflict of interest: T. Tonia is an ERS methodologist. Conflict of interest: N. Roche reports grants and personal fees from Boehringer Ingelheim, Novartis and Pfizer, personal fees from GSK, AstraZeneca, Chiesi, Sanofi and Zambon, outside the submitted work. Conflict of interest: J.D. Chalmers reports grants and personal fees from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline and Insmed, grants from Gilead Sciences, personal fees from Chiesi, Novartis and Zambon, outside the submitted work.

Figures

FIGURE 1
FIGURE 1
Forest plots showing the effects of corticosteroids and interleukin (IL)-6 receptor antagonists on mortality of hospitalised adult patients with coronavirus disease 2019. Study name has been used unless no name was available, in which case the trial registration identifier has been used. The weight represents the percentage contribution of each study to the summary effect estimate.
FIGURE 2
FIGURE 2
Forest plots showing the effects of hydroxychloroquine (HCQ), azithromycin (AZ) and hydroxychloroquine in combination with azithromycin on mortality of hospitalised adult patients with coronavirus disease 2019. Study name has been used unless no name was available, in which case the trial registration identifier has been used. The weight represents the percentage contribution of each study to the summary effect estimate.
FIGURE 3
FIGURE 3
Forest plots showing the effects of lopinavir/ritonavir and remdesivir on mortality of hospitalised adult patients with coronavirus disease 2019. Study name has been used unless no name was available, in which case the trial registration identifier has been used. The weight represents the percentage contribution of each study to the summary effect estimate.
FIGURE 4
FIGURE 4
Forest plots showing the effects of colchicine and interferon-β on mortality of hospitalised adult patients with coronavirus disease 2019. Study name has been used unless no name was available, in which case the trial registration identifier has been used. The weight represents the percentage contribution of each study to the summary effect estimate.
FIGURE 5
FIGURE 5
Summary of recommendations from the European Respiratory Society (ERS) guidelines for hospitalised patients with coronavirus disease 2019 (COVID-19).
See this image and copyright information in PMC

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