Drug treatments for covid-19: living systematic review and network meta-analysis (update)
Updated review includes results for new interventions (azithromycin, colchicine, interferons, rhG-CSF, tocilizumab) and evidence remdesivir may not reduce mortality or time to symptom resolution; glucocorticoids probably reduce length of ICU stay and increase ventilator-free days
Source:
British Medical Journal
SPS commentary:
This update included 50 additional RCTs (n=25,081). The certainty for the effects of the new interventions included (azithromycin, colchicine, interferon beta, interferon gamma, interferon kappa plus trefoil factor 2, rhG-CSF, tocilizumab) was low or very low. New evidence suggests remdesivir may not reduce mortality (low certainty) or time to symptom resolution (moderate certainty); previously the evidence suggested a benefit for these outcomes, and glucocorticoids probably reduce length of hospital stay (low certainty) and increase ventilator-free days (moderate certainty). Hydroxychloroquine, lopinavir/ritonavir, and interferon beta may not reduce mortality or mechanical ventilation, and they seem unlikely to have any other benefits. The effects of most drug interventions are currently highly uncertain.
This is the third version of the living systematic review and network meta-analysis. It directly informs the development of the WHO living guideline on therapeutics and Covid-19, and BMJ Rapid Recommendations on Covid-19 treatments. The WHO guideline has been updated to include a new strong recommendation against the use of hydroxychloroquine and lopinavir/ritonavir in patients with Covid-19, regardless of disease severity.