PMID- 32360583 OWN - NLM STAT- MEDLINE DCOM- 20200629 LR - 20231113 IS - 1096-1186 (Electronic) IS - 1043-6618 (Print) IS - 1043-6618 (Linking) VI - 157 DP - 2020 Jul TI - Efficacy and safety of current therapeutic options for COVID-19 - lessons to be learnt from SARS and MERS epidemic: A systematic review and meta-analysis. PG - 104872 LID - S1043-6618(20)31180-4 [pii] LID - 10.1016/j.phrs.2020.104872 [doi] AB - The rapidly progressing of coronavirus disease 2019 (COVID-19) pandemic has become a global concern. This meta-analysis aimed at evaluating the efficacy and safety of current option of therapies for severe acute respiratory syndrome (SARS), Middle Eastern respiratory syndrome (MERS) besides COVID-19, in an attempt to identify promising therapy for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients. We searched PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), and WANFANG DATA for randomized controlled trials (RCTs), prospective cohort, and retrospective cohort studies that evaluated therapies (hydroxychloroquine, lopinavir/ritonavir-based therapy, and ribavirin-based therapy, etc.) for SARS, MERS, and COVID-19. The primary outcomes were mortality, virological eradication and clinical improvement, and secondary outcomes were improvement of symptoms and chest radiography results, incidence of acute respiratory disease syndrome (ARDS), utilization of mechanical ventilation, and adverse events (AEs). Summary relative risks (RRs) and 95% confidence intervals (CIs) were calculated using random-effects models, and the quality of evidence was appraised using GRADEpro. Eighteen articles (5 RCTs, 2 prospective cohort studies, and 11 retrospective cohort studies) involving 4,941 patients were included. Compared with control treatment, anti-coronary virus interventions significantly reduced mortality (RR 0.65, 95% CI 0.44-0.96; I(2) = 81.3%), remarkably ameliorate clinical improvement (RR 1.52, 95% CI 1.05-2.19) and radiographical improvement (RR 1.62, 95% CI 1.11-2.36, I(2) = 11.0 %), without manifesting clear effect on virological eradication, incidence of ARDS, intubation, and AEs. Subgroup analyses demonstrated that the combination of ribavirin and corticosteroids remarkably decreased mortality (RR 0.43, 95% CI 0.27-0.68). The lopinavir/ritonavir-based combination showed superior virological eradication and radiographical improvement with reduced rate of ARDS. Likewise, hydroxychloroquine improved radiographical result. For safety, ribavirin could induce more bradycardia, anemia and transaminitis. Meanwhile, hydroxychloroquine could increase AEs rate especially diarrhea. Overall, the quality of evidence on most outcomes were very low. In conclusion, although we could not draw a clear conclusion for the recommendation of potential therapies for COVID-19 considering the very low quality of evidence and wide heterogeneity of interventions and indications, our results may help clinicians to comprehensively understand the advantages and drawbacks of each anti-coronavirus agents on efficacy and safety profiles. Lopinavir/ritonavir combinations might observe better virological eradication capability than other anti-coronavirus agents. Conversely, ribavirin might cause more safety concerns especially bradycardia. Thus, large RCTs objectively assessing the efficacy of antiviral therapies for SARS-CoV-2 infections should be conducted with high priority. CI - Copyright (c) 2020 Elsevier Ltd. All rights reserved. FAU - Zhong, Han AU - Zhong H AD - Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, China; Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, China. FAU - Wang, Yan AU - Wang Y AD - Department of Pharmacy, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, China. FAU - Zhang, Zai-Li AU - Zhang ZL AD - Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, China. FAU - Liu, Yang-Xi AU - Liu YX AD - Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, China. FAU - Le, Ke-Jia AU - Le KJ AD - Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, China. FAU - Cui, Min AU - Cui M AD - Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, China. FAU - Yu, Yue-Tian AU - Yu YT AD - Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, China. Electronic address: fishyyt@sina.com. FAU - Gu, Zhi-Chun AU - Gu ZC AD - Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, China. Electronic address: guzhichun213@163.com. FAU - Gao, Yuan AU - Gao Y AD - Department of Critical Care Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, China. FAU - Lin, Hou-Wen AU - Lin HW AD - Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200127, China. Electronic address: franklin67@163.com. LA - eng PT - Journal Article PT - Meta-Analysis PT - Research Support, Non-U.S. Gov't PT - Systematic Review DEP - 20200430 PL - Netherlands TA - Pharmacol Res JT - Pharmacological research JID - 8907422 RN - 0 (Antiviral Agents) SB - IM CIN - Pharmacol Res. 2020 Oct;160:105055. PMID: 32619723 MH - Antiviral Agents/adverse effects/*therapeutic use MH - Betacoronavirus/drug effects MH - COVID-19 MH - Coronavirus Infections/*drug therapy MH - Humans MH - Pandemics MH - Pneumonia, Viral/*drug therapy MH - SARS-CoV-2 MH - Severe Acute Respiratory Syndrome/*drug therapy PMC - PMC7192121 OTO - NOTNLM OT - COVID-19 OT - MERS OT - SARS OT - efficacy OT - safety OT - therapeutic options COIS- Declaration of Competing Interest None conflicts of interest to declare. EDAT- 2020/05/04 06:00 MHDA- 2020/07/01 06:00 PMCR- 2020/04/30 CRDT- 2020/05/04 06:00 PHST- 2020/04/22 00:00 [received] PHST- 2020/04/24 00:00 [revised] PHST- 2020/04/24 00:00 [accepted] PHST- 2020/05/04 06:00 [pubmed] PHST- 2020/07/01 06:00 [medline] PHST- 2020/05/04 06:00 [entrez] PHST- 2020/04/30 00:00 [pmc-release] AID - S1043-6618(20)31180-4 [pii] AID - 104872 [pii] AID - 10.1016/j.phrs.2020.104872 [doi] PST - ppublish SO - Pharmacol Res. 2020 Jul;157:104872. doi: 10.1016/j.phrs.2020.104872. Epub 2020 Apr 30.