ABSTRACT: RATIONALE: Coronavirus disease 2019 (COVID-19) has spread worldwide and poses a threat to humanity. However, no specific therapy has been established for this disease yet. We conducted a systematic review to highlight therapeutic agents that might be effective in treating COVID-19. METHODS: We searched Medline, Medrxiv.org, and reference lists of relevant publications to identify articles of in vitro, in vivo, and clinical studies on treatments for severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and COVID-19 published in English until the last update on October 11, 2020. RESULTS: We included 36 studies on SARS, 30 studies on MERS, and 10 meta-analyses on SARS and MERS in this study. Through 12,200 title and 830 full-text screenings for COVID-19, eight in vitro studies, 46 randomized controlled trials (RCTs) on 6,886 patients, and 29 meta-analyses were obtained and investigated. There was no therapeutic agent that consistently resulted in positive outcomes across SARS, MERS, and COVID-19. Remdesivir showed a therapeutic effect for COVID-19 in two RCTs involving the largest number of total participants (n = 1,461). Other therapies that showed an effect in at least two RCTs for COVID-19 were sofosbuvir/daclatasvir (n = 114), colchicine (n = 140), IFN-β1b (n = 193), and convalescent plasma therapy (n = 126). CONCLUSIONS: This review provides information to help establish treatment and research directions for COVID-19 based on currently available evidence. Further RCTs are required.
OBJECTIVE: To evaluate the efficacy and safety of ribavirin for COVID-19 by systematically reviewing previous clinical studies of coronavirus pneumonia. METHODS: Such databases as Pubmed, EMbase, Cochrane Library, Google Scholar, CNKI, Wanfang Data, VIP and CBM were searched. The date of the latest search was April 29, 2020. Clinical studies on ribavirin used in the severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) were included. The literature was screened according to the inclusion and exclusion criteria and the methodological quality of the included studies was assessed by two reviewers independently. Meta-analysis was performed using Review Manager 5.3 software. RESULTS: In total, 7 studies were included, resulting in a sample size of 870 cases. The overall pooled data demonstrated that the difference in mortality rates between the ribavirin group and control group was not statistically significant in the treatment of SARS and MERS[OR=1.10,95％CI（0.79,1.55）,P=0.57]. In the subgroup analysis, the mortality rate was not significantly different between the ribavirin group and control group in the treatment of SARS and MERS whether ribavirin was combined with interferon or not. CONCLUSION: Ribavirin does not make much difference to mortality in the treatment of SARS and MERS, but it can increase drug safety risks. Thus, the applicability of ribavirin in the treatment of COVID-19 remains to be investigated
INTRODUCTION: Within this large-scale study, we compared clinical symptoms, laboratory findings, radiographic signs, and outcomes of COVID-19, SARS, and MERS to find unique features.
METHOD: We searched all relevant literature published up to February 28, 2020. Depending on the heterogeneity test, we used either random or fixed-effect models to analyze the appropriateness of the pooled results. Study has been registered in the PROSPERO database (ID 176106).
RESULT: Overall 114 articles included in this study; 52 251 COVID-19 confirmed patients (20 studies), 10 037 SARS (51 studies), and 8139 MERS patients (43 studies) were included. The most common symptom was fever; COVID-19 (85.6%, P < .001), SARS (96%, P < .001), and MERS (74%, P < .001), respectively. Analysis showed that 84% of Covid-19 patients, 86% of SARS patients, and 74.7% of MERS patients had an abnormal chest X-ray. The mortality rate in COVID-19 (5.6%, P < .001) was lower than SARS (13%, P < .001) and MERS (35%, P < .001) between all confirmed patients.
CONCLUSIONS: At the time of submission, the mortality rate in COVID-19 confirmed cases is lower than in SARS- and MERS-infected patients. Clinical outcomes and findings would be biased by reporting only confirmed cases, and this should be considered when interpreting the data.
INTRODUCTION: In the current time where we face a COVID-19 pandemic, prevention, and rapid diagnosis of infected patients is crucial. Within this large-scale study, we compared clinical symptoms, laboratory findings, radiographic signs, and outcomes of COVID-19, SARS, and MERS to find unique features. METHOD: We searched all relevant literature published up to February 28, 2020, from Embase, Scopus, PubMed, Web of Science, and the Cochrane library to collect the studies that reported clinical and laboratory characteristics of corona-infected patients. The study quality was assessed with the Critical Appraisal Checklist. Depending on the heterogeneity test, we used either random or fixed-effect models to analyze the appropriateness of the pooled results. RESULT: Overall 114 articles included in this study; 52,251 COVID-19 confirmed patients (20 studies), 10,037 SARS (51 studies), and 8,139 MERS patients (43 studies) were included. The most common symptom among COVID-19 85.6 % (95% CI 73 -93, p < 0.001), SARS 96 % (95% CI 93-97.6, p < 0.001), and MERS 74 % (95% CI 63.5 -83.5, p < 0.001) was fever, respectively. Analysis showed that 84 % (95% CI 78-8.5, p < 0.001) of COVID-19 patients, 86% (95% 77-92, p < 0.001) of SARS patients, and 74.7% (95% 56.5-87, p < 0.001) of MERS patients had an abnormal chest X-ray. The mortality rate in COVID-19 5.6% (95% CI 2.5-12.5, p < 0.001), SARS 13 % (95% 9-17, p < 0.001), and MERS were 35 % (95% CI 31-39, p < 0.001) between all confirmed patients. CONCLUSIONS: Fever and cough are the most common symptoms of COVID-19, SARS, and MERS infected patients. Thrombocytosis in COVID-19 patients was more than twice as frequent as in SARS, and MERS confirmed cases. At the time of submission, the mortality rate in COVID-19 confirmed cases is lower than SARS and MERS infected patients. Clinical outcomes and findings would be biased by reporting only confirmed cases, and it should be considered when interpreting the data.
The Middle East Respiratory Syndrome coronavirus (MERS-CoV) has been detected in a number of countries in the Middle East and Europe with an apparently high mortality rate. It is phylogenetically related to the SARS coronavirus and has also been associated with severe respiratory illness as well as nosocomial transmission in healthcare settings. Current international recommendations do not support any specific therapies; however, there are a number of agents, which were used during the SARS epidemic of 2003. It is possible that these might be active against the related MERS coronavirus. We have reviewed the literature on the safety and efficacy of therapies used in patients with SARS with a view to their potential use in patients with MERS-CoV infections.
Background: The SARS outbreak of 2002-2003 presented clinicians with a new, life-threatening disease for which they had no experience in treating and no research on the effectiveness of treatment options. The World Health Organization (WHO) expert panel on SARS treatment requested a systematic review and comprehensive summary of treatments used for SARS-infected patients in order to guide future treatment and identify priorities for research. Methods and Findings: In response to the WHO request we conducted a systematic review of the published literature on ribavirin, corticosteroids, lopinavir and ritonavir (LPV/r), type I interferon (IFN), intravenous immunoglobulin (IVIG), and SARS convalescent plasma from both in vitro studies and in SARS patients. We also searched for clinical trial evidence of treatment for acute respiratory distress syndrome. Sources of data were the literature databases MEDLINE, EMBASE, BIOSIS, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to February 2005. Data from publications were extracted and evidence within studies was classified using predefined criteria. In total, 54 SARS treatment studies, 15 in vitro studies, and three acute respiratory distress syndrome studies met our inclusion criteria. Within in vitro studies, ribavirin, lopinavir, and type I IFN showed inhibition of SARS-CoV in tissue culture. In SARS-infected patient reports on ribavirin, 26 studies were classified as inconclusive, and four showed possible harm. Seven studies of convalescent plasma or IVIG, three of IFN type I, and two of LPV/r were inconclusive. In 29 studies of steroid use, 25 were inconclusive and four were classified as causing possible harm. Conclusions: Despite an extensive literature reporting on SARS treatments, it was not possible to determine whether treatments benefited patients during the SARS outbreak. Some may have been harmful. Clinical trials should be designed to validate a standard protocol for dosage and timing, and to accrue data in real time during future outbreaks to monitor specific adverse effects and help inform treatment.
Coronavirus disease 2019 (COVID-19) has spread worldwide and poses a threat to humanity. However, no specific therapy has been established for this disease yet. We conducted a systematic review to highlight therapeutic agents that might be effective in treating COVID-19.
METHODS:
We searched Medline, Medrxiv.org, and reference lists of relevant publications to identify articles of in vitro, in vivo, and clinical studies on treatments for severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and COVID-19 published in English until the last update on October 11, 2020.
RESULTS:
We included 36 studies on SARS, 30 studies on MERS, and 10 meta-analyses on SARS and MERS in this study. Through 12,200 title and 830 full-text screenings for COVID-19, eight in vitro studies, 46 randomized controlled trials (RCTs) on 6,886 patients, and 29 meta-analyses were obtained and investigated. There was no therapeutic agent that consistently resulted in positive outcomes across SARS, MERS, and COVID-19. Remdesivir showed a therapeutic effect for COVID-19 in two RCTs involving the largest number of total participants (n = 1,461). Other therapies that showed an effect in at least two RCTs for COVID-19 were sofosbuvir/daclatasvir (n = 114), colchicine (n = 140), IFN-β1b (n = 193), and convalescent plasma therapy (n = 126).
CONCLUSIONS:
This review provides information to help establish treatment and research directions for COVID-19 based on currently available evidence. Further RCTs are required.
