Diallo Alhassane, Carlos-Bolumbu Miguel, Traoré Marie, Diallo Mamadou Hassimiou, Jedrecy Christophe
INSERM, CIC 1411, CHU of Montpellier, St Eloi Hospital, University of Montpellier.
Urgences Réanimation Centre Hospitalier Sud Essonnes CHSE, Paris.
J Public Health Res. 2021 Feb 3;10(1):1945. doi: 10.4081/jphr.2021.1945. eCollection 2021 Jan 14.
To date, there is no definite effective treatment for the COVID- 19 pandemic. We performed an update network meta-analysis to compare and rank COVID-19 treatments according to their efficacy and safety. Literature search was performed from MEDLINE and CENTRAL databases from inception to September 5, 2020. Randomized clinical trials (RCTs) which compared the effect of any pharmacological drugs versus standard care or placebo 28-day after hospitalization in adult patients with COVID-19 disease were included. Risk ratio (RR) and 95% CI were calculated for 28-day all-cause mortality, clinical improvement, any adverse event (AEs), and viral clearance. A total of 25 RCTs, evaluating 17 different treatments, and 11,597 participants were analyzed. Remdesivir for 10- day compared to standard care (RR 0.69, 95% CI [0.48-0.99]), and a low dose compared to a high dose of HCQ (0.38, [0.17-0.89]) were associated with a lower risk of death. A total of 2,766 patients experienced clinical improvement, a 5-day course of remdesivir was associated with a higher frequency of clinical improvement compared to standard care (RR 1.21, 95% CI [1.00-1.47]). Compared to standard care, remdesivir for both 5 and 10 days, lopinavir/ritonavir, and dexamethasone reduced the risk of any severe AEs by 52% (0.48, 0.34-0.67), 24% (0.77, 0.63-0.92), 40% (0.60, 0.37-0.98), and 50% (0.50, 0.25-0.98) respectively. In this study of hospitalized patients with COVID-19, administration of remdesivir for 10-day compared to standard care was associated with lower 28-day all-cause mortality and serious AEs, and higher clinical improvement rate.
迄今为止，对于新冠疫情尚无确切有效的治疗方法。我们进行了一项更新的网络荟萃分析，以根据疗效和安全性对新冠治疗方法进行比较和排序。从MEDLINE和CENTRAL数据库建库至2020年9月5日进行文献检索。纳入了比较任何药物与标准治疗或安慰剂对成年新冠患者住院28天后疗效的随机临床试验（RCT）。计算了28天全因死亡率、临床改善情况、任何不良事件（AE）和病毒清除率的风险比（RR）及95%置信区间（CI）。共分析了25项评估17种不同治疗方法的RCT及11597名参与者。与标准治疗相比，10天疗程的瑞德西韦（RR 0.69，95%CI[0.48 - 0.99]），以及低剂量与高剂量羟氯喹相比（0.38，[0.17 - 0.89]）与较低的死亡风险相关。共有2766例患者实现临床改善，与标准治疗相比，5天疗程的瑞德西韦临床改善频率更高（RR 1.21，95%CI[1.00 - 1.47]）。与标准治疗相比，5天和10天疗程的瑞德西韦、洛匹那韦/利托那韦以及地塞米松分别使任何严重不良事件的风险降低了52%（0.48，0.34 - 0.67）、24%（0.77，0.63 - 0.92）、40%（0.60，0.37 - 0.98）和50%（0.50，0.25 - 0.98）。在这项针对住院新冠患者的研究中，与标准治疗相比，10天疗程的瑞德西韦与较低的28天全因死亡率和严重不良事件以及较高的临床改善率相关。
