Clinical effectiveness of drugs in hospitalized patients with COVID-19: a systematic review and meta-analysis

The aim was to assess the clinical effectiveness of drugs used in hospitalized patients with COVID-19 infection. We conducted a systematic review of randomized clinical trials assessing treatment with remdesivir, chloroquine, hydroxychloroquine, lopinavir, ritonavir, dexamethasone, and convalescent plasma, for hospitalized patients with a diagnosis of SARS-CoV-2 infection. The outcomes were mortality, clinical improvement, duration of ventilation, duration of oxygen support, duration of hospitalization, virological clearance, and severe adverse events. A total of 48 studies were retrieved from the databases. Eleven articles were finally included in the data extraction and qualitative synthesis of results. The meta-analysis suggests a benefit of dexamethasone versus standard care in the reduction of risk of mortality at day 28; and the clinical improvement at days 14 and 28 in patients treated with remdesivir. We can conclude that dexamethasone would have a better result in hospitalized patients, especially in low-resources settings. The analysis of the main treatments proposed for hospitalized patients is of vital importance to reduce mortality in low-income countries, since the COVID-19 pandemic had an economic impact worldwide with the loss of jobs and economic decline in countries with scarce resources. The reviews of this paper are available via the supplemental material section.

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Clinical effectiveness of drugs in hospitalized patients with COVID-19 infection: a systematic review and meta-analysis.

10.1101/2020.09.11.20193011 ◽

2020 ◽

Author(s):

Roberto Ariel Abeldano Zuniga ◽

Silvia Coca ◽

Giuliana Abeldano ◽

Ruth Ana Maria Gonzalez Villoria

Keyword(s):

Systematic Review ◽

Clinical Improvement ◽

Low Income ◽

Randomized Clinical Trials ◽

Data Extraction ◽

Meta Analysis ◽

Clinical Effectiveness ◽

Hospitalized Patients ◽

Low Income Countries ◽

Qualitative Synthesis

Objective. The aim was to assess the clinical effectiveness of drugs used in hospitalized patients with COVID-19 infection. Method. We conducted a systematic review of randomized clinical trials assessing treatment with remdesivir, chloroquine, hydroxychloroquine, lopinavir, ritonavir, dexamethasone, and convalescent plasma, for hospitalized patients with a diagnosis of SARS-CoV-2 infection. The outcomes were mortality, clinical improvement, duration of ventilation, duration of oxygen support, duration of hospitalization), virological clearance, and severe adverse events. Results. A total of 48 studies were retrieved from the databases. Ten articles were finally included in the data extraction and qualitative synthesis of results. The meta-analysis suggests a benefit of dexamethasone versus standard care in the reduction of risk of mortality at day 28; and the clinical improvement at days 14 and 28 in patients treated with remdesivir. Conclusions. Dexamethasone would have a better result in hospitalized patients, especially in low-resources settings. Significance of results. The analysis of the main treatments proposed for hospitalized patients is of vital importance to reduce mortality in low-income countries; since the COVID-19 pandemic had an economic impact worldwide with the loss of jobs and economic decline in countries with scarce resources. Keywords: Drugs; Antivirals; Clinical improvement; Mortality; COVID-19; SARS-CoV2.

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Clinical effectiveness of drugs in hospitalized patients with COVID-19: a systematic review and meta-analysis

10.21203/rs.3.rs-76791/v1 ◽

2020 ◽

Author(s):

Roberto Ariel Abeldaño ◽

Silvia Mercedes Coca ◽

Giuliana Florencia Abeldaño ◽

Ruth Ana María González Villoria

Keyword(s):

Systematic Review ◽

Clinical Improvement ◽

Low Income ◽

Randomized Clinical Trials ◽

Data Extraction ◽

Meta Analysis ◽

Clinical Effectiveness ◽

Hospitalized Patients ◽

Low Income Countries ◽

Qualitative Synthesis

Abstract Objective: The aim was to assess the clinical effectiveness of drugs used in hospitalized patients with COVID-19 infection.Method: We conducted a systematic review of randomized clinical trials assessing treatment with remdesivir, chloroquine, hydroxychloroquine, lopinavir, ritonavir, dexamethasone, and convalescent plasma, for hospitalized patients with a diagnosis of SARS-CoV-2 infection. The outcomes were mortality, clinical improvement, duration of ventilation, duration of oxygen support, duration of hospitalization), virological clearance, and severe adverse events.Results: A total of 48 studies were retrieved from the databases. Ten articles were finally included in the data extraction and qualitative synthesis of results. The meta-analysis suggests a benefit of dexamethasone versus standard care in the reduction of risk of mortality at day 28; and the clinical improvement at days 14 and 28 in patients treated with remdesivir.Conclusions: Dexamethasone would have a better result in hospitalized patients, especially in low-resources settings.Significance of results: The analysis of the main treatments proposed for hospitalized patients is of vital importance to reduce mortality in low-income countries; since the COVID-19 pandemic had an economic impact worldwide with the loss of jobs and economic decline in countries with scarce resources.

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Clinical effectiveness of convalescent plasma in hospitalized patients with COVID-19: a systematic review and meta-analysis

Therapeutic Advances in Respiratory Disease ◽

10.1177/17534666211028077 ◽

2021 ◽

Vol 15 ◽

pp. 175346662110280

Author(s):

Roberto Ariel Abeldaño Zuñiga ◽

Ruth Ana María González-Villoria ◽

María Vanesa Elizondo ◽

Anel Yaneli Nicolás Osorio ◽

David Gómez Martínez ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Clinical Improvement ◽

Data Extraction ◽

Meta Analysis ◽

Clinical Effectiveness ◽

Risk Of Bias ◽

Hospitalized Patients ◽

Low Risk ◽

Controlled Clinical Trials

Aims: Given the variability of previously reported results, this systematic review aims to determine the clinical effectiveness of convalescent plasma employed in the treatment of hospitalized patients diagnosed with COVID-19. Methods: We conducted a systematic review of controlled clinical trials assessing treatment with convalescent plasma for hospitalized patients diagnosed with SARS-CoV-2 infection. The outcomes were mortality, clinical improvement, and ventilation requirement. Results: A total of 51 studies were retrieved from the databases. Five articles were finally included in the data extraction and qualitative and quantitative synthesis of results. The overall risk of bias in the reviewed articles was established at low-risk only in two trials. The meta-analysis suggests that there is no benefit of convalescent plasma compared with standard care or placebo in reducing the overall mortality and the ventilation requirement. However, there could be a benefit for the clinical improvement in patients treated with plasma. Conclusion: Current results led to assume that the convalescent plasma transfusion cannot reduce the mortality or ventilation requirement in hospitalized patients diagnosed with SARS-CoV-2 infection. More controlled clinical trials conducted with methodologies that ensure a low risk of bias are still needed. The reviews of this paper are available via the supplemental material section.

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Clinical effectiveness of convalescent plasma in hospitalized patients with COVID-19: a systematic review and meta-analysis

10.1101/2021.01.16.21249956 ◽

2021 ◽

Author(s):

Roberto Ariel Abeldaño Zuñiga ◽

Ruth Ana María González Villoria ◽

María Vanesa Elizondo ◽

Anel Yaneli Nicolás Osorio ◽

Silvia Mercedes Coca

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Clinical Improvement ◽

Data Extraction ◽

Meta Analysis ◽

Clinical Effectiveness ◽

Hospitalized Patients ◽

Controlled Clinical Trials ◽

Quantitative Synthesis ◽

Overall Mortality

AbstractGiven the variability of previously reported results, this systematic review aims to determine the clinical effectiveness of convalescent plasma employed in the treatment of hospitalized patients with diagnosis of COVID-19.We conducted a systematic review of controlled clinical trials assessing treatment with convalescent plasma for hospitalized patients with a diagnosis of SARS-CoV-2 infection. The outcomes were mortality, clinical improvement, and ventilation requirement.A total of 50 studies were retrieved from the databases. Four articles were finally included in the data extraction, qualitative and quantitative synthesis of results. The meta-analysis suggests that there is no benefit of convalescent plasma compared to standard care or placebo in the reduction of the overall mortality and in the ventilation requirement; but there could be a benefit for the clinical improvement in patients treated with plasma.We can conclude that the convalescent plasma transfusion cannot reduce the mortality or ventilation requirement in hospitalized patients diagnosed with SARS-CoV-2 infection. More controlled clinical trials conducted with methodologies that ensure a low risk of bias are still needed.

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Misuse of medication in adult substance misuse services: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2020-047283 ◽

2021 ◽

Vol 11 (6) ◽

pp. e047283

Author(s):

Rosalind Gittins ◽

Louise Missen ◽

Ian Maidment

Keyword(s):

Systematic Review ◽

Substance Misuse ◽

Data Extraction ◽

Meta Analysis ◽

Grey Literature ◽

Opioid Analgesics ◽

Physical And Mental Health ◽

Qualitative Synthesis ◽

Treatment Services ◽

The Impact

IntroductionThere is a growing concern about the misuse of over the counter (OTC) and prescription only medication (POM) because of the impact on physical and mental health, drug interactions, overdoses and drug-related deaths. These medicines include opioid analgesics, anxiolytics such as pregabalin and diazepam and antidepressants. This protocol outlines how a systematic review will be undertaken (during June 2021), which aims to examine the literature on the pattern of OTC and POM misuse among adults who are accessing substance misuse treatment services. It will include the types of medication being taken, prevalence and demographic characteristics of people who access treatment services.Methods and analysisAn electronic search will be conducted on the Cochrane, OVID Medline, Pubmed, Scopus and Web of Science databases as well as grey literature. Two independent reviewers will conduct the initial title and abstract screenings, using predetermined criteria for inclusion and exclusion. If selected for inclusion, full-text data extraction will be conducted using a pilot-tested data extraction form. A third reviewer will resolve disagreements if consensus cannot be reached. Quality and risk of bias assessment will be conducted for all included studies. A qualitative synthesis and summary of the data will be provided. If possible, a meta-analysis with heterogeneity calculation will be conducted; otherwise, Synthesis Without Meta-analysis will be undertaken for quantitative data. The reporting of this protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Ethics and disseminationEthical approval is not required. Findings will be peer reviewed, published and shared verbally, electronically and in print, with interested clinicians and policymakers.PROSPERO registration numberCRD42020135216.

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DPP4 Inhibitors in the Management of Hospitalized Patients With Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Advances in Therapy ◽

10.1007/s12325-020-01434-7 ◽

2020 ◽

Vol 37 (9) ◽

pp. 3660-3675

Author(s):

Soghra Rabizadeh ◽

Mohammad Ali Tavakoli Ardakani ◽

Marjan Mouodi ◽

Masoume Bitaraf ◽

Sakineh Shab-Bidar ◽

...

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Clinical Trials ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Hospitalized Patients ◽

Dpp4 Inhibitors

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Acupuncture for Managing Cancer-Related Insomnia: A Systematic Review of Randomized Clinical Trials

Integrative Cancer Therapies ◽

10.1177/1534735416664172 ◽

2016 ◽

Vol 16 (2) ◽

pp. 135-146 ◽

Cited By ~ 19

Author(s):

Tae-Young Choi ◽

Jong In Kim ◽

Hyun-Ja Lim ◽

Myeong Soo Lee

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Sleep Quality ◽

Randomized Clinical Trials ◽

Data Extraction ◽

Meta Analysis ◽

Sham Acupuncture ◽

Risk Of Bias ◽

The Other ◽

Level Of Evidence

Background. Insomnia is a prominent complaint of cancer patients that can significantly affect their quality of life and symptoms related to sleep quality. Conventional drug approaches have a low rate of success in alleviating those suffering insomnia. The aim of this systematic review was to assess the efficacy of acupuncture in the management of cancer-related insomnia. Methods. A total of 12 databases were searched from their inception through January 2016 without language restriction. Randomized controlled trials (RCTs) and quasi-RCTs were included if acupuncture was used as the sole intervention or as an adjunct to another standard treatment for any cancer-related insomnia. The data extraction and the risk of bias assessments were performed by 2 independent reviewers. Results. Of the 90 studies screened, 6 RCTs were included. The risk of bias was generally unclear or low. Three RCTs showed equivalent effects on the Pittsburgh Sleep Quality Index and 2 RCTs showed the similar effects on response rate to those of conventional drugs at the end of treatment. The other RCT showed acupuncture was better than hormone therapy in the numbers of hours slept each night and number of times woken up each night. The 3 weeks of follow-up in 2 RCTs showed superior effects of acupuncture compared with conventional drugs, and a meta-analysis showed significant effects of acupuncture. Two RCTs tested the effects of acupuncture on cancer-related insomnia compared with sham acupuncture. One RCT showed favourable effects, while the other trial failed to do so. Conclusion. There is a low level of evidence that acupuncture may be superior to sham acupuncture, drugs or hormones therapy. However, the number of studies and effect size are small for clinical significance. Further clinical trials are warranted.

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Global epidemiology of COVID-19 knowledge, attitude and practice: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2021-051447 ◽

2021 ◽

Vol 11 (9) ◽

pp. e051447

Author(s):

Bodrun Naher Siddiquea ◽

Aishwarya Shetty ◽

Oashe Bhattacharya ◽

Afsana Afroz ◽

Baki Billah

Keyword(s):

Systematic Review ◽

General Population ◽

Low Income ◽

Meta Analysis ◽

Good Practice ◽

Low Income Countries ◽

Middle Income ◽

Attitude And Practice ◽

Global Epidemiology ◽

Knowledge Attitude And Practice

ObjectiveTo assess the knowledge, attitude and practice (KAP) of the global general population regarding COVID-19.DesignSystematic review and meta-analysis.MethodsMEDLINE, Embase, CINAHL and PsycINFO were used to identify articles published between 1 January and 30 June 2021 assessing KAP regarding COVID-19 in the global general population. The quality of eligible studies was assessed. Random effects model was used to obtain the pooled proportion of each component of KAP of COVID-19. Heterogeneity (I2) was tested, and subgroup and correlation analyses were performed.ResultsOut of 3099 records, 84 studies from 45 countries across all continents assessing 215 731 participants’ COVID-19 KAP were included in this study. The estimated overall correct answers for knowledge, good attitude and good practice in this review were 75% (95% CI 72% to 77%), 74% (95% CI 71% to 77%) and 70% (95% CI 66% to 74%), respectively. Low-income countries, men, people aged below 30 years and people with 12 years of education or less had the lowest practice scores. Practice scores were below 60% in Africa and Europe/Oceania. Overall heterogeneity was high (I2 ≥98%), and publication bias was present (Egger’s regression test, p<0.01). A positive significant correlation between knowledge and practice (r=0.314, p=0.006), and attitude and practice (r=0.348, p=0.004) was observed.ConclusionsThis study’s findings call for community-based awareness programmes to provide a simple, clear and understandable message to reinforce knowledge especially regarding efficacy of the preventive measures in low and lower middle-income countries, and in Africa and Europe/Oceania, which will translate into good practice. Targeted intervention for men, people with low education, unemployed people and people aged below 30 years should be recommended. As most of the included studies were online surveys, underprivileged and remote rural people may have been missed out. Additional studies are needed to cover heterogeneous populations.PROSPERO registration numberCRD42020203476.

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Efficacy of Modern Diabetes Treatments- Dpp-4i, Sglt-2i, Glp-1ra- in White and Asian Patients With Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

10.2337/figshare.12003276.v1 ◽

2020 ◽

Author(s):

Sushrima Gan1 ◽

Adem Y Dawed ◽

Louise A Donnelly ◽

ATN Nair ◽

Colin NA Palmer ◽

...

Keyword(s):

Systematic Review ◽

Randomized Clinical Trials ◽

Data Extraction ◽

Meta Analysis ◽

Controlled Trials ◽

Glucose Lowering ◽

Asian Ethnicity ◽

Mesh Terms ◽

Oral Agents ◽

The Impact

Background and Purpose:The pathophysiology of Type 2 diabetes differs markedly by ethnicity. A systematic review and meta-analysis was conducted to assess the impact of ethnicity on the glucose lowering efficacy of the newer oral agents, SGLT-2is, GLP-1RAs and DPP-4is, using evidence from randomized clinical trials (RCTs). Data Sources:A literature search was conducted in PubMed of all randomized, placebo-controlled trials of DPP-4 inhibitors, SGLT-2 inhibitors and GLP-1RA. The search strategy was developed based on medical subject sub-headings (MeSH) terms and keywords. Study selection : 64 studies qualified for meta-analysis after full-text review based on pre-defined inclusion and exclusion criteria. RCTs with at least 50 patients in each arm; >70% of population from Asian or White group; duration>=24 weeks; published up to March 2019 were selected for systematic review and meta-analysis. Data extraction:Data extraction was done for aggregated study-level data , by two independent researchers. Absolute changes in HbA1c (%) from baseline to 24 weeks between the drug and placebo was considered as the primary endpoint of the study. Data synthesis: Change in HbA1c was evaluated by computing mean differences (MDs) and 95% confidence intervals (CI) between treatment and placebo arms. Limitations: Study is based on summarized data and could not be separated based on East Asians and South Asians. Conclusion : The glucose lowering efficacy of SGLT-2i, and to a lesser extent DPP-4i, was greater in studies of predominantly Asian ethnicity compared to studies of predominantly white ethnicity. There was no difference seen by ethnicity for GLP-1RA.

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