Comparative effectiveness and safety of 32 pharmacological interventions recommended by guidelines for coronavirus disease 2019:a systematic review and network meta-analysis combining 66 trials  

作　　者：Shan-Shan Wu Qing-Xin Zhou Xue-Yang Zeng Jing-Xue Zhang Zhi-Rong Yang Qing-Qing Yang Zi-Lu Zhang Ya-Hong Chen Feng Sun Si-Yan Zhan 

机构地区：[1]Department of Epidemiology and Biostatistics,School of Public Health,Peking University Health Science Centre,Beijing 100191,China [2]Department of Clinical Epidemiology and EBM,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China [3]National Clinical Research Center of Digestive Diseases,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China [4]Primary Care Unit,Department of Public Health and Primary Care,School of Clinical Medicine,University of Cambridge,Cambridge CB18RN,UK [5]Department of Clinical Epidemiology and Biostatistics,McMaster University,Hamilton L8S4K1,Canada [6]Department of Respiratory and Critical Care Medicine,Peking University Third Hospital,Beijing 100191,China.

出　　处：《Chinese Medical Journal》2021年第16期1920-1929,共10页中华医学杂志（英文版）

基　　金：the National Natural Science Foundation of China(No.72074011);the Special Project for Major Infectious Disease of Peking University Health Program of China(No.BMU2020HKYZX010);the National Key Technology R&D Program of China(No.2020YFC0840800).

摘　　要：Background:The global pandemic coronavirus disease 2019(COVID-19)has become a major public health problem and presents an unprecedented challenge.However,no specific drugs were currently proven.This study aimed to evaluate the comparative efficacy and safety of pharmacological interventions in patients with COVID-19.Methods:Medline,Embase,the Cochrane Library,and clinicaltrials.gov were searched for randomized controlled trials(RCTs)in patients infected with severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)/SARS-CoV.Random-effects network metaanalysis within the Bayesian framework was performed,followed by the Grading of Recommendations Assessment,Development,and Evaluation system assessing the quality of evidence.The primary outcome of interest includes mortality,cure,viral negative conversion,and overall adverse events(OAEs).Odds ratio(OR)with 95%confidence interval(CI)was calculated as the measure of effect size.Results:Sixty-six RCTs with 19,095 patients were included,involving standard of care(SOC),eight different antiviral agents,six different antibiotics,high and low dose chloroquine(CQ_HD,CQ_LD),traditional Chinese medicine(TCM),corticosteroids(COR),and other treatments.Compared with SOC,a significant reduction of mortality was observed for TCM(OR=0.34,95%CI:0.20–0.56,moderate quality)and COR(OR=0.84,95%CI:0.75–0.96,low quality)with improved cure rate(OR=2.16,95%CI:1.60–2.91,low quality for TCM;OR=1.17,95%CI:1.05–1.30,low quality for COR).However,an increased risk of mortality was found for CQ_HD vs.SOC(OR=3.20,95%CI:1.18–8.73,low quality).TCM was associated with decreased risk of OAE(OR=0.52,95%CI:0.38–0.70,very low quality)but CQ_HD(OR=2.51,95%CI:1.20–5.24)and interferons(IFN)(OR=2.69,95%CI:1.02–7.08)vs.SOC with very low quality were associated with an increased risk.Conclusions:COR and TCM may reduce mortality and increase cure rate with no increased risk of OAEs compared with standard care.CQ_HD might increase the risk of mortality.CQ,IFN,and other antiviral agents could incr

关 键 词：SARS-CoV-2 COVID-19 Pharmacological intervention Network meta-analysis EFFECTIVENESS SAFETY 

分 类 号：R563.1[医药卫生—呼吸系统]