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Review
Evaluation of current medical approaches for COVID-19: a systematic review and meta-analysis
  1. Meng Wang1,2,3,
  2. Ting Wu1,4,5,
  3. Zhihong Zuo1,2,
  4. Yaxian You1,
  5. Xinyuan Yang1,2,
  6. Liangyu Pan1,
  7. Ying Hu1,
  8. Xuan Luo6,
  9. Liping Jiang2,
  10. Zanxian Xia4,7 and
  11. Meichun Deng1,2,4
  1. 1 Department of Biochemistry and Molecular Biology, School of Life Sciences, Central South University, Changsha, Hunan 410013, China
  2. 2 Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China
  3. 3 Department of Nephrology, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
  4. 4 Hunan Province Key Laboratory of Basic and Applied Hematology, Hunan Key Laboratory of Animal Models for Human Diseases, Hunan Key Laboratory of Medical Genetics & Center for Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan 410013, China
  5. 5 Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
  6. 6 Hunan Yuanpin Cell Biotechnology Co., Ltd, Changsha, Hunan 410129, China
  7. 7 Department of Cell Biology, School of Life Sciences, Central South University, Changsha, Hunan 410013, China
  1. Correspondence to Dr Meichun Deng, Central South University, Changsha, Hunan, China; dengmch{at}csu.edu.cn

Abstract

Background Because of the lack of vaccination, it is urgent to find effective antiviral agents for COVID-19 treatment.

Method Online databases were searched for articles published before or on 22 June 2020. Studies reporting the effectiveness and safety of antiviral agents for COVID-19 were analysed.

Results A total of 42 studies were included in this analysis. Hydroxychloroquine (HCQ) was not associated with the incidence of death (risk ratio (RR)=1.08; 95% CI 0.81 to 1.44) and severe cases (RR=1.05; 95% CI 0.61 to 1.81). Patients treated with HCQ obtained few benefits with respect to the clearance of viral RNA and were more likely to have adverse reactions. HCQ treatment could shorten the body temperature recovery time (weighted mean difference = −1.04; 95% CI −1.64 to −0.45). Lopinavir/ritonavir (LPV/r) (RR=0.90; 95% CI 0.76 to 1.07) and Arbidol (RR=1.09; 95% CI 0.92 to 1.29) were not associated with the negative conversion rate. Integrative Chinese-Western medicine alleviated clinical symptoms and decreased the incidence of severe cases (RR=0.38; 95% CI 0.25 to 0.59). Remdesivir treatment reduced the 14-day mortality rate of patients with severe COVID-19 (RR=0.64; 95% CI 0.44 to 0.94). Convalescent plasma (CP) tended to increase the negative conversion rate (RR=2.47; 95% CI 1.70 to 3.57).

Conclusion HCQ, LPV/r and Arbidol bring little benefit in COVID-19 treatment. Integrative Chinese-Western medicine improved the clinical symptoms of patients with COVID-19. Remdesivir and CP might be the potential treatments for patients with severe COVID-19. However, large-scale clinical randomised trials are needed to validate our conclusions.

  • lung
  • pharmacology
  • hospital care

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bmjspcare-2020-002554

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    Footnotes

    • MW, TW and ZZ contributed equally.

    • Contributors MW, TW, ZZ, YY, XY, LP, YH, XL, LJ, ZX and MD contributed to the material collection, data analysis and manuscript writing. All authors read and approved the final manuscript.

    • Funding This work was supported by the National Natural Science Foundation of China under contract (Nos. 31672290, 31100764, 30901874), the National Key Research and Development Program of China (2016YFD0500300), Zhejiang University Special Scientific Research Fund for COVID-19 Prevention and Control (2020XGZX033), the Natural Science Foundation of Hunan Province, China (No. 2016JJ3180), Open-End Fund for the Valuable and Precision Instruments of Central South University (Nos. CSUZC2020043).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.