Interventions for treatment of COVID-19: A living systematic review with meta-analyses and trial sequential analyses (The LIVING Project)

Sophie Juul, Emil Eik Nielsen, Joshua Feinberg, Faiza Siddiqui, Caroline Kamp Jørgensen, Emily Barot, Niklas Nielsen, Peter Bentzer, Areti Angeliki Veroniki, Lehana Thabane, Fanlong Bu, Sarah Klingenberg, Christian Gluud and Janus Christian Jakobsen

PLOS Medicine, 2020, vol. 17, issue 9, 1-25

Abstract: Background: Coronavirus disease 2019 (COVID-19) is a rapidly spreading disease that has caused extensive burden to individuals, families, countries, and the world. Effective treatments of COVID-19 are urgently needed. Methods and findings: This is the first edition of a living systematic review of randomized clinical trials comparing the effects of all treatment interventions for participants in all age groups with COVID-19. We planned to conduct aggregate data meta-analyses, trial sequential analyses, network meta-analysis, and individual patient data meta-analyses. Our systematic review is based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and Cochrane guidelines, and our 8-step procedure for better validation of clinical significance of meta-analysis results. We performed both fixed-effect and random-effects meta-analyses. Primary outcomes were all-cause mortality and serious adverse events. Secondary outcomes were admission to intensive care, mechanical ventilation, renal replacement therapy, quality of life, and nonserious adverse events. We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the certainty of evidence. We searched relevant databases and websites for published and unpublished trials until August 7, 2020. Two reviewers independently extracted data and assessed trial methodology. Conclusions: Our results show that dexamethasone and remdesivir might be beneficial for COVID-19 patients, but the certainty of the evidence was low to very low, so more trials are needed. We can exclude the possibility of hydroxychloroquine versus standard care reducing the risk of death and serious adverse events by 20% or more. Otherwise, no evidence-based treatment for COVID-19 currently exists. This review will continuously inform best practice in treatment and clinical research of COVID-19. Sophie Juul and colleagues initiate a living systematic review including meta-analyses on treatments for COVID-19.Why was this study done?: What did the researchers do and find?: What do these findings mean?:

Date: 2020
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pmed00:1003293

DOI: 10.1371/journal.pmed.1003293

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