Drug treatments for covid-19: living systematic review and network meta-analysis

This living systematic review and network meta-analysis (23 RCTs currently) found glucocorticoids were the only intervention shown to reduce the risk of death (risk difference 37 fewer per 1000 patients) and need for mechanical ventilation (31 fewer per 1000 patients).

SPS commentary:

This living systematic review and network meta-analysis provides a comprehensive overview and assessment of the evidence published as of 20 July 2020 and will be updated periodically.

The authors note that currently the effectiveness of most interventions is uncertain, because most of the RCTs published to date have been small and associated with important limitations, such as high risk of bias (lack of blinding) and serious imprecision.

Remdesivir was found to reduce the duration of mechanical ventilation compared with standard care (mean difference −5.15 days, 95% credible interval −8.28 to −2.0 days; moderate certainty) and decrease symptom duration (−2.58 days; 95% CI −4.32 to −0.54 days) with no additional harm beyond standard care (moderate certainty evidence).

A linked clinical practice guideline makes a weak recommendation for the use of remdesivir in severe covid-19 while recommending continuation of active enrolment of patients into ongoing RCTs.   

Although hydroxychloroquine may reduce symptom duration versus standard care (mean difference −4.5 days, −5.98 to −2.99 days; low certainty), it might increase the risk of adverse events compared with the other interventions. Lopinavir-ritonavir may reduce symptom duration (−1.22 days, −2.00 to −0.37, low certainty evidence).


British Medical Journal

Resource links:


Linked guideline on remdesivir