Division of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas.
Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan.
J Med Virol. 2021 Feb;93(2):775-785. doi: 10.1002/jmv.26302. Epub 2020 Jul 22.
Treatment options for severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) are limited with no clarity on efficacy and safety profiles. We performed a systematic review and meta-analysis of studies on patients ≥18 years reporting data on therapeutic interventions in SARS-CoV-2. Primary outcome was all-cause mortality and secondary outcomes were rates of mechanical ventilation, viral clearance, adverse events, discharge, and progression to severe disease. Pooled rates and odds ratios (OR) were calculated. Twenty-nine studies with 5207 patients were included. Pooled all-cause mortality in intervention arm was 12.8% (95% confidence interval [CI]: 8.1%-17.4%). Mortality was significantly higher for studies using hydroxychloroquine (HCQ) for intervention (OR: 1.36; 95% CI: 0.97-1.89). Adverse events were also higher in HCQ subgroup (OR: 3.88; 95% CI: 1.60-9.45). There was no difference in other secondary outcomes. There is a need for well-designed randomized clinical trials for further investigation of every therapeutic intervention for further insight into different therapeutic options.
治疗严重急性呼吸综合征相关冠状病毒 2(SARS-CoV-2)的方法有限,其疗效和安全性尚不清楚。我们对≥18 岁的患者进行了一项系统评价和荟萃分析,这些患者报告了 SARS-CoV-2 治疗干预的数据。主要结局是全因死亡率,次要结局是机械通气、病毒清除、不良事件、出院和疾病进展的发生率。计算了汇总率和比值比(OR)。纳入了 29 项研究,共 5207 例患者。干预组的全因死亡率为 12.8%(95%置信区间:8.1%-17.4%)。使用羟氯喹(HCQ)进行干预的研究死亡率显著更高(OR:1.36;95%置信区间:0.97-1.89)。HCQ 亚组的不良事件发生率也更高(OR:3.88;95%置信区间:1.60-9.45)。其他次要结局无差异。需要进行精心设计的随机临床试验,以进一步研究每种治疗干预措施,以深入了解不同的治疗选择。