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Meta-Analysis
. 2022 Dec;42(12):1031-1047.
doi: 10.1007/s40261-022-01213-y. Epub 2022 Oct 31.

The Effect of Nitazoxanide on the Clinical Outcomes in Patients with COVID-19: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Mohamed Abuelazm  1 , Ahmed Ghanem  2 , Ahmed K Awad  3 , Ramadan Abdelmoez Farahat  4 , Fatma Labieb  5 , Basant E Katamesh  6 , Basel Abdelazeem  7   8
Affiliations
Meta-Analysis

The Effect of Nitazoxanide on the Clinical Outcomes in Patients with COVID-19: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Mohamed Abuelazm et al. Clin Drug Investig. 2022 Dec.

Abstract

Background and objective: Nitazoxanide, a US Food and Drug Administration-approved antiparasitic agent, was reported to be effective in treating coronavirus disease 2019 (COVID-19). The lack of effective and precise treatments for COVID-19 infection earlier in the pandemic forced us to depend on symptomatic, empirical, and supportive therapy, which overburdened intensive care units and exhausted hospital resources. Therefore, the aim of this systematic review and meta-analysis was to assess the efficacy and safety of nitazoxanide for COVID-19 treatment.

Methods: A systematic review and meta-analysis synthesizing relevant randomized controlled trials from six databases (MedRxiv, WOS, SCOPUS, EMBASE, PubMed, and CENTRAL) until 17 May 2022 was conducted. Risk ratio (RR) for dichotomous outcomes was used and data with a 95% confidence interval (CI) are presented. The protocol was registered in PROSPERO with ID: CRD42022334658.

Results: Six randomized controlled trials with 1412 patients were included in the analysis. Nitazoxanide was effective in accelerating viral clearance compared with placebo (RR: 1.30 with 95% CI 1.08, 1.56, p = 0.006) and reducing oxygen requirements (RR: 0.48 with 95% CI 0.39, 0.59, p = 0.00001), but we found no difference between nitazoxanide and placebo in improving clinical resolution (RR: 1.01 with 95% CI 0.94, 1.08, p = 0.88), reducing the mortality rate (RR: 0.88 with 95% CI 0.4, 1.91, p = 0.74), and intensive care unit admission (RR: 0.69 with 95% CI 0.43, 1.13, p = 0.14). Moreover, nitazoxanide was as safe as placebo (RR: 0.9 with 95% CI 0.72, 1.12, p = 0.34).

Conclusions: Compared with placebo, nitazoxanide was effective in expediting viral clearance and decreasing oxygen requirements. However, there was no difference between nitazoxanide and placebo regarding clinical response, all-cause mortality, and intensive care unit admission. Therefore, more large-scale studies are still needed to ascertain the clinical applicability of nitazoxanide in COVID-19.

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Conflict of interest statement

Mohamed Abuelazm, Ahmed Ghanem, Ahmed K. Awad, Ramadan Abdelmoez Farahat, Fatma Labieb, Basant E. Katamesh, and Basel Abdelazeem have no conflicts of interest that are directly relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flow chart of the screening process
Fig. 2
Fig. 2
Summary of risk of bias. A Review authors’ judgments about each risk of bias item for each included study and B review authors’ judgments about each risk of bias item presented as percentages across all included studies
Fig. 3
Fig. 3
Forest plot of the primary outcome. A Viral clearance and B viral clearance subgroubed by the time of assessment. CI confidence interval, M-H Mantel-Haenszel method
Fig. 4
Fig. 4
Forest plot of the secondary outcomes. A Clinical resolution, B all-cause mortality, C intensive care unit admission, and D oxygen requirement. CI confidence interval, M-H Mantel-Haenszel method
Fig. 5
Fig. 5
Forest plot of the safety outcomes. A Patients with at least one adverse event and B adverse events. CI confidence interval, M-H Mantel-Haenszel method
See this image and copyright information in PMC

References

    1. Valencia DN. Brief review on COVID-19: the 2020 pandemic caused by SARS-CoV-2. Cureus. 2020;12:e7386. - PMC - PubMed
    1. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. J Am Med Assoc. 2020;323:1239–1242. doi: 10.1001/jama.2020.2648. - DOI - PubMed
    1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. doi: 10.1016/S0140-6736(20)30183-5. - DOI - PMC - PubMed
    1. Rello J, Storti E, Belliato M, Serrano R. Clinical phenotypes of SARS-CoV-2: implications for clinicians and researchers. Eur Respir J. 2020;55(5):2001028. doi: 10.1183/13993003.01028-2020. - DOI - PMC - PubMed
    1. Cascella M, Rajnik M, Aleem A, Dulebohn SC, Di Napoli R. Features, evaluation, and treatment of coronavirus (COVID-19). In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. - PubMed

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