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干预措施治疗 COVID-19:包含个体患者数据的活系统评价与网络荟萃分析的方案(LIVING 项目)。

Interventions for treatment of COVID-19: a protocol for a living systematic review with network meta-analysis including individual patient data (The LIVING Project).

机构信息

Copenhagen Trial Unit - Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.

Department of Clinical Sciences Lund, Anesthesia & Intensive care, Helsingborg Hospital, Lund University, Lund, Sweden.

出版信息

Syst Rev. 2020 May 9;9(1):108. doi: 10.1186/s13643-020-01371-0.


DOI:10.1186/s13643-020-01371-0
PMID:32386514
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7210799/
Abstract

BACKGROUND: COVID-19 is a rapidly spreading virus infection that has quickly caused extensive burden to individual, families, countries, and the globe. No intervention has yet been proven effective for the treatment of COVID-19. Some randomized clinical trials assessing the effects of different drugs have been published, and more are currently underway. There is an urgent need for a living, dynamic systematic review that continuously evaluates the beneficial and harmful effects of all available interventions for COVID-19. METHODS/DESIGN: We will conduct a living systematic review based on searches of major medical databases (e.g., MEDLINE, EMBASE, CENTRAL) and clinical trial registries from their inception onwards to identify relevant randomized clinical trials. We will update the literature search once a week to continuously assess if new evidence is available. Two review authors will independently extract data and perform risk of bias assessment. We will include randomized clinical trials comparing any intervention for the treatment of COVID-19 (e.g., pharmacological interventions, fluid therapy, invasive or noninvasive ventilation, or similar interventions) with any comparator (e.g., an "active" comparator, standard care, placebo, no intervention, or "active placebo") for participants in all age groups with a diagnosis of COVID-19. Primary outcomes will be all-cause mortality and serious adverse events. Secondary outcomes will be admission to intensive care, mechanical ventilation, renal replacement therapy, quality of life, and non-serious adverse events. The living systematic review will include aggregate data meta-analyses, Trial Sequential Analyses, network meta-analysis, and individual patient data meta-analyses. Risk of bias will be assessed with domains, an eight-step procedure will be used to assess if the thresholds for clinical significance are crossed, and the certainty of the evidence will be assessed by Grading of Recommendations, Assessment, Development and Evaluations (GRADE). DISCUSSION: COVID-19 has become a pandemic with substantial mortality. A living systematic review evaluating the beneficial and harmful effects of pharmacological and other interventions is urgently needed. This review will continuously inform best practice in treatment and clinical research of this highly prevalent disease. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020178787.

摘要

背景:COVID-19 是一种迅速传播的病毒感染,已迅速给个人、家庭、国家和全球带来了巨大负担。目前尚无有效的干预措施被证明可用于治疗 COVID-19。一些评估不同药物效果的随机临床试验已经发表,目前还有更多的试验正在进行中。目前迫切需要进行一项实时的、动态的系统评价,以不断评估所有针对 COVID-19 的现有干预措施的有益和有害影响。

方法/设计:我们将对主要医学数据库(如 MEDLINE、EMBASE、CENTRAL)和临床试验注册中心进行实时搜索,以确定相关的随机临床试验,从而开展实时系统评价。我们将每周更新一次文献搜索,以持续评估是否有新的证据。两名综述作者将独立提取数据并进行偏倚风险评估。我们将纳入比较任何 COVID-19 治疗干预措施(如药理学干预、液体疗法、有创或无创通气或类似干预)与任何对照(如“活性”对照、标准护理、安慰剂、无干预或“活性安慰剂”)的随机临床试验,纳入所有年龄段的 COVID-19 确诊患者。主要结局为全因死亡率和严重不良事件。次要结局为入住重症监护病房、机械通气、肾脏替代治疗、生活质量和非严重不良事件。实时系统评价将包括汇总数据荟萃分析、试验序贯分析、网络荟萃分析和个体患者数据荟萃分析。偏倚风险将通过领域进行评估,将采用八步程序评估是否跨越了临床意义的阈值,证据的确定性将通过推荐、评估、发展和评估(GRADE)进行评估。

讨论:COVID-19 已成为一种具有高死亡率的大流行疾病。迫切需要进行实时系统评价,以评估药理学和其他干预措施的有益和有害影响。该综述将不断为这种高度流行疾病的治疗和临床研究提供最佳实践信息。

系统评价注册:PROSPERO CRD42020178787。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a42a/7211336/e26dc4002ba3/13643_2020_1371_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a42a/7211336/e26dc4002ba3/13643_2020_1371_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a42a/7211336/e26dc4002ba3/13643_2020_1371_Fig1_HTML.jpg

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本文引用的文献

[1]
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JAMA. 2020-5-12

[2]
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N Engl J Med. 2020-3-18

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BMJ Evid Based Med. 2021-6

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Cochrane Database Syst Rev. 2019-10-3

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