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Meta-Analysis
. 2024 Mar;56(3):102771.
doi: 10.1016/j.aprim.2023.102771. Epub 2023 Nov 28.

Effectiveness of antidepressants in improving the prognosis of COVID-19: A systematic review and meta-analysis

Raquel Cobos-Campos  1 , Arantxa Sáez de Lafuente-Moríñigo  2 , Jose Aurelio Cordero-Guevara  2 , Cristina Bermúdez-Ampudia  2 , Antxon Apiñaniz  3 , Naiara Parraza  2
Affiliations
Meta-Analysis

Effectiveness of antidepressants in improving the prognosis of COVID-19: A systematic review and meta-analysis

Raquel Cobos-Campos et al. Aten Primaria. 2024 Mar.

Abstract
in English, Spanish

Objective, and material and methods: A systematic review and meta-analysis was performed to evaluate the effectiveness of antidepressants in reducing the poor evolution of COVID-19 disease (a composite variable including death, hospitalization and need for mechanical ventilation), and mortality, according the guidelines for Systematic Reviews of Interventions published by the Cochrane library.

Source of data: MEDLINE, EMBASE and COCHRANE LIBRARY were consulted up to February 25, 2022. Unpublished studies were searched on clinicaltrials.gov platform.

Selection of studies: Seven masked and unmasked, observational and experimental studies evaluating death, hospitalization and need for mechanical ventilation were selected. A second subgroup analysis with mortality variable was performed.

Data extraction: A full risk of bias assessment was performed addressing issues such as information and confounding bias. ROB2 and Robins-I tools for randomized and no randomized studies were employed respectively. In the quantitative analysis, the risk of publication bias, heterogeneity, estimation of pooled measure and a sensitivity analysis was performed. The pooled final measure was calculated as odds ratio with its correspondent 95% confidence interval. A random effects model was used for this purpose due to the heterogeneity between included studies. Finally, a sensitivity analysis was performed to assess the robustness of final pooled measure.

Results: Seven studies were finally considered to calculate the final pooled measure. The effect of intervention was OR 0.73; 95% CI 0.56-0.94.

Conclusions: The use of antidepressants, and specially SSRI could be effective for reducing the risk of poor progression of COVID-19 disease.

Objetivo, y material y métodos: Se realizó una revisión sistemática y un metaanálisis para evaluar la eficacia de los antidepresivos en la reducción de la mala evolución de la enfermedad COVID-19 (variable compuesta que incluye muerte, hospitalización y necesidad de ventilación mecánica), y mortalidad, según las directrices para Revisiones Sistemáticas de Intervenciones publicadas por la biblioteca Cochrane.

Fuente de datos: Se consultaron MEDLINE, EMBASE y la biblioteca Cochrane hasta el 25 de febrero de 2022. Se realizaron búsquedas de estudios no publicados en la plataforma clinicaltrials.gov.

Selección de estudios: Se seleccionaron estudios observacionales y experimentales, enmascarados y no enmascarados, que evaluaron la muerte, la hospitalización y la necesidad de ventilación mecánica. Se realizó un segundo análisis de subgrupos con la variable mortalidad.

Extracción de datos: Se realizó una evaluación completa del riesgo de sesgo que abordó temas como el sesgo de información y los factores de confusión. Se emplearon las herramientas Rob2 y Robins-I para los estudios aleatorios y no aleatorios, respectivamente. En el análisis cuantitativo, se analizó el sesgo de publicación, heterogeneidad, y se estimó la medida combinada global. La medida final se calculó como odds ratio con su correspondiente intervalo de confianza del 95%. Para ello se utilizó un modelo de efectos aleatorios debido a la heterogeneidad entre los estudios incluidos.

Finalmente, se realizó un análisis de sensibilidad para evaluar la robustez de la medida final estimada.

Resultados: Se consideraron 7 estudios para calcular la medida agrupada final. El efecto de la intervención (tratamiento con antidepresivos) fue OR 0,73; IC 95% 0,56-0,94.

Conclusiones: El uso de antidepresivos, y especialmente de ISRS, podría ser eficaz para reducir el riesgo de mala evolución y mortalidad de la enfermedad COVID-19.

Keywords: Antidepresivos; Antidepressants; COVID-19; Covid-19; Inhibidores selectivos de la recaptación de serotonina; Selective serotonin reuptake inhibitors.

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Figures

Figure 1
Figure 1
PRISMA 2009 flow diagram. From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6(6):e1000097. doi:10.1371/journal.pmed.1000097. Prisma statement check list included in Supplementary file.
Figure 2
Figure 2
Risk of bias of non-random studies.
Figure 3
Figure 3
Poor progression of COVID-19 disease. Comparison of antidepressant users versus routine practice.
Figure 4
Figure 4
Poor progression of COVID-19 disease. Comparison of antidepressant users versus routine practice excluding Hoertel's study.
Figure 5
Figure 5
Mortality by COVID-19 disease. Comparison of antidepressant users versus routine practice.
Figure 6
Figure 6
GRADE certainty of the evidence judgements.
See this image and copyright information in PMC

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