Department of Surgery, Division of Trauma and Acute Care Surgery, Kendall Regional Medical Center, Miami, FL, USA.
Department of Surgery, Division of Trauma and Acute Care Surgery, Kendall Regional Medical Center, Miami, FL, USA; Department of Surgery, University of South Florida, Tampa, FL, USA.
Am J Emerg Med. 2020 Nov;38(11):2405-2415. doi: 10.1016/j.ajem.2020.08.091. Epub 2020 Sep 1.
There is a pressing need for COVID-19 transmission control and effective treatments. We aim to evaluate the safety and effectiveness of SARS-CoV-2 pharmacologic therapies as of August 2, 2020 according to study level of evidence.
PubMed, ScienceDirect, Cochrane Library, JAMA Network and PNAS were searched. The following keywords were used: ((COVID-19) OR (SARS-CoV-2)) AND ((((((therapeutics) OR (treatment)) OR (vaccine)) OR (hydroxychloroquine)) OR (antiviral)) OR (prognosis)). Results included peer-reviewed studies published in English.
15 peer-reviewed articles met study inclusion criteria, of which 14 were RCTs and one was a systematic review with meta-analysis. The following pharmacologic therapies were evaluated: chloroquine (CQ), hydroxychloroquine (HCQ), antivirals therapies, plasma therapy, anti-inflammatories, and a vaccine.
According to level 1 evidence reviewed here, the most effective SARS-Co-V-2 pharmacologic treatments include remdesivir for mild to severe disease, and a triple regimen therapy consisting of lopinavir-ritonavir, ribavirin and interferon beta-1b for mild to moderate disease. Also, dexamethasone significantly reduced mortality in those requiring respiratory support. However, there is still a great need for detailed level 1 evidence on pharmacologic therapies.
目前迫切需要控制 COVID-19 的传播并提供有效的治疗方法。本研究旨在根据研究证据水平评估截至 2020 年 8 月 2 日 SARS-CoV-2 药物治疗的安全性和有效性。
检索了 PubMed、ScienceDirect、Cochrane Library、JAMA Network 和 PNAS 数据库。使用了以下关键词：((COVID-19) 或 (SARS-CoV-2)) 和 (((((治疗方法) 或 (治疗) 或 (疫苗) 或 (羟氯喹)) 或 (抗病毒药)) 或 (预后))。结果包括以英文发表的同行评议研究。
15 篇符合纳入标准的同行评议文章，其中 14 篇为 RCT，1 篇为系统评价和荟萃分析。评估了以下药物治疗方法：氯喹 (CQ)、羟氯喹 (HCQ)、抗病毒治疗、血浆治疗、抗炎药和疫苗。
根据本研究综述的 1 级证据，最有效的 SARS-CoV-2 药物治疗方法包括瑞德西韦治疗轻至重度疾病，以及洛匹那韦-利托那韦、利巴韦林和干扰素β-1b 三联疗法治疗轻至中度疾病。此外，地塞米松显著降低了需要呼吸支持的患者的死亡率。然而，仍然需要详细的 1 级证据来评估药物治疗方法。
