背景:迄今为止,关于什么药物是治疗重症COVID-19患者的“最佳”药物,几乎没有达成一致。本研究旨在评估目前可用的不同药物治疗重症COVID-19的疗效和安全性。
方法:我们在数据库中搜索了截至2022年2月28日发表的随机对照试验(RCT),没有语言限制。推荐用于患有严重COVID-19感染的患者(16岁或以上)的药物。我们提取了有关试验和患者特征的数据,和以下主要结果:全因死亡率(ACM),和治疗引起的不良事件(TEAE)。
结果:我们通过数据库搜索和其他来源确定了4021份摘要,其中包括48份RCT,包括9147名参与者。对于ACM的减少,我们发现伊维菌素/多西环素,C-IVIG(即,超免疫抗COVID-19静脉注射免疫球蛋白),甲基强的松龙,干扰素-β/标准护理(SOC),干扰素-β-1b,恢复期血浆,remdesivir,洛匹那韦/利托那韦,免疫球蛋白γ,高剂量sarilumab(HS),auxora,与安慰剂组或SOC组相比,伊马替尼有效。我们发现秋水仙碱和干扰素-β/SOC仅与重症COVID-19患者的TEAE相关。
结论:这项研究表明,伊维菌素/强力霉素,C-IVIG,甲基强的松龙,干扰素-β/SOC,干扰素-β-1b,恢复期血浆(CP),remdesivir,洛匹那韦/利托那韦,免疫球蛋白γ,HS,auxora,和伊马替尼治疗重症COVID-19患者有效。我们发现,大多数药物在治疗重症COVID-19方面是安全的。仍需要更大规模的RCT来证实本研究的结果。
BACKGROUND: To date, there has been little agreement on what drug is the \"best\" drug for treating severe COVID-19 patients. This study aimed to assess the efficacy and safety of different medications available at present for severe COVID-19.
METHODS: We searched databases for randomized controlled trials (RCTs) published up to February 28, 2022, with no language restrictions, of medications recommended for patients (aged 16 years or older) with severe COVID-19 infection. We extracted data on trials and patient characteristics, and the following primary outcomes: all-cause mortality (ACM), and treatment-emergent adverse events (TEAEs).
RESULTS: We identified 4021 abstracts and of these included 48 RCTs comprising 9147 participants through database searches and other sources. For decrease in ACM, we found that ivermectin/doxycycline, C-IVIG (i.e., a hyperimmune anti-COVID-19 intravenous immunoglobulin), methylprednisolone, interferon-beta/standard-of-care (SOC), interferon-beta-1b, convalescent plasma, remdesivir, lopinavir/ritonavir, immunoglobulin gamma, high dosage sarilumab (HS), auxora, and imatinib were effective when compared with placebo or SOC group. We found that colchicine and interferon-beta/SOC were only associated with the TEAEs of severe COVID-19 patients.
CONCLUSIONS: This study suggested that ivermectin/doxycycline, C-IVIG, methylprednisolone, interferon-beta/SOC, interferon-beta-1b, convalescent plasma (CP), remdesivir, lopinavir/ritonavir, immunoglobulin gamma, HS, auxora, and imatinib were efficacious for treating severe COVID-19 patients. We found that most medications were safe in treating severe COVID-19. More large-scale RCTs are still needed to confirm the results of this study.