Navigating Therapeutic Frontiers: A Meta-review and Meta-analysis of COVID-19 Treatment Options

Abstract

To assess the efficacy and safety of each therapeutic options in the treatment of COVID-19 by assessing the evidence from existing systematic reviews and meta-analyses, and to carry out an umbrella meta-analysis of all meta-analysis studies to assess the efficacy of each drug. A comprehensive search was carried out in electronic databases for systematic reviews and meta-analyses which compared the efficacy and/or safety of therapeutic options in the treatment of COVID-19. Findings from the reviews were synthesized using tables and forest plots and the pooled estimate of effect size using the DerSimonian and Laird method was used for the updated meta-analysis. The main outcome was mortality. 285 reviews with 152 meta-analyses were included, The analysis of systematic reviews contents indicated that most reviewed drugs were as follows: chroquine/hydroxychloroquine (n = 48), tocilizumab (n = 39), remdesivir (n = 25), corticosteroids (n = 25), JAK inhibitors (n = 12), colchicine (n = 11), ivermectin (n = 8), anakinra (n = 7), favipravir (n = 7), lopinavir/ritonavir (n = 6), ACEI/ARB (n = 6), azithromycin (n = 4), sofosbuvir (n = 4), and Vitamin D (n = 4). Findings from the included reviews suggested that tocilizumab, remdesivir, corticosteroids, JAKI, anakinra, colchicine, ivermectin, and sofosbuvir decreased the rate of mortality significantly in those taking the drugs; otherwise hydroxylchroquine increased the risk of mortality significantly, while Lopinavir/Ritonavir had no benefit and ACEI and azithromycin decreased mortality rate not significantly. lower requirement for mechanical ventilation and intensive care unit admission and a shorter hospital length of stay was observed with the tocilizumab, JAKIs, anakinra, corticosteroids and sofosbuvir Only one third of the included reviews had 70 quality based on the AMSTAR scale assessment. The results of this study have the potential to be a useful tool for the translation of health evidence and for designing the decision support systems for evidence synthesis.