Drug treatments for covid-19: living systematic review and network meta-analysis

摘要: Abstract Objective To compare the effects of treatments for coronavirus disease 2019 (covid-19). Design Living systematic review and network meta-analysis. Data sources WHO covid-19 database, a comprehensive multilingual source global literature, up to 3 December 2020 six additional Chinese databases 12 November 2020. Study selection Randomised clinical trials in which people with suspected, probable, or confirmed were randomised drug treatment standard care placebo. Pairs reviewers independently screened potentially eligible articles. Methods After duplicate data abstraction, bayesian meta-analysis was conducted. Risk bias included studies assessed using modification Cochrane risk 2.0 tool, certainty evidence grading recommendations assessment, development evaluation (GRADE) approach. For each outcome, interventions classified groups from most least beneficial harmful following GRADE guidance. Results 85 enrolling 41 669 patients met inclusion criteria as 21 October 2020; 50 (58.8%) 25 081 (60.2%) are new previous iteration; 43 (50.6%) evaluating at 100 20 events threshold analyses. Compared care, corticosteroids probably reduce death (risk difference 17 fewer per 1000 patients, 95% credible interval 34 1 more, moderate certainty), mechanical ventilation (29 54 days free (2.6 fewer, 0.2 5.0 certainty). The impact remdesivir on mortality, ventilation, length hospital stay, duration symptoms is uncertain, but it does not substantially increase adverse leading discontinuation (0 more 1000, 9 40 Azithromycin, hydroxychloroquine, lopinavir/ritonavir, interferon-beta, tocilizumab may have an effect any other patient-important outcome. all low very low. Conclusion Corticosteroids mortality compared whereas azithromycin, either. Whether confers benefit remains uncertain. Systematic registration This registered. protocol supplement. Readers’ note article living that will be updated reflect emerging evidence. Updates occur two years date original publication. version second update published 30 July (BMJ 2020;370:m2980), versions can found supplements. When citing this paper please consider adding number access clarity.