Systematic Review on the Therapeutic Options for COVID-19: Clinical Evidence of Drug Efficacy and Implications.
Systematic Review on the Therapeutic Options for COVID-19: Clinical Evidence of Drug Efficacy and Implications.
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DOI：
10.2147/idr.s289037
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发表时间：
2020
影响因子：
3.9
通讯作者：
Haque M
中科院分区：
文献类型：
--
作者：
Abubakar AR;Sani IH;Godman B;Kumar S;Islam S;Jahan I;Haque M
一种新的冠状病毒-2(SARS-CoV-2)在武汉首次发现，中国，并迅速在全球传播。已经提出了几种治疗方法，其中许多被证明是无效的。因此，有必要审查已发表的药物临床试验证据，以指导未来的处方。对已发表的临床试验和回溯性观察研究进行了系统综述。使用PubMed、Embase、MEDLINE和中国国家知识基础设施数据库进行检索。检索了2020年1月至2020年10月发表的以英语撰写的文章，并将其纳入研究。使用传统药物的研究、体外和体内动物研究以及综述被排除在外。最终选择了73篇符合纳入标准的相关文章并进行了综述。在随机对照临床试验(RCT)中，羟氯喹、氯喹和阿奇霉素没有临床疗效的证据。然而，回溯性的观察性研究报告了瑞培韦和洛匹那韦/利托那韦在降低病毒载量方面的效果，尽管有人对洛匹那韦/利托那韦和最近的瑞培韦表示担忧。最近，托奇珠单抗、地塞米松和甲基强的松龙显著缓解了重症新冠肺炎患者的肺部炎症并降低了死亡率。此外，恢复期血浆对轻度新冠肺炎患者较强的免疫力有较好的增强作用。尽管包括羟氯喹在内的药物最初被炒作，但目前还没有单一的全球批准的新冠肺炎患者的治疗方案。尽管如此，地塞米松在对症治疗和恢复期血浆提高免疫力方面显示出了希望。目前正在研究新的治疗方法，并将相应地报告研究结果，为处方者和政策制定者提供循证指导。
A novel coronavirus-2 (SARS-CoV-2) was first identified in Wuhan, China, and quickly spread globally. Several treatments have been proposed, many of which have proven ineffective. Consequently, there is a need to review the published evidence of drug clinical trials to guide future prescribing. A systematic review of published clinical trials and retrospective observational studies was carried out. The search was made using PubMed, Embase, MEDLINE, and China National Knowledge Infrastructure (CNKI) databases. Articles published between January 2020 and October 2020 and written in the English language were retrieved and included in the study. Researches that used traditional medicine, in-vitro and in-vivo animal studies, as well as reviews were excluded. Seventy-three relevant articles that fulfilled the inclusion criteria were finally selected and reviewed. Hydroxychloroquine, chloroquine, and azithromycin produced no clinical evidence of efficacy in randomized controlled clinical trials (RCT). However, retrospective observational studies reported the efficacy of remdesivir and lopinavir/ritonavir in reducing viral load, although there have been concerns with lopinavir/ritonavir and, more recently, remdesivir. Recently, tocilizumab, dexamethasone, and methylprednisolone significantly relieved lung inflammation and decreased mortality in patients with severe COVID-19. In addition, convalescent plasma was effective in boosting strong immunity among patients with mild COVID-19. There is currently no single worldwide approved therapeutic option for patients with COVID-19 despite the initial hype with medicines, including hydroxychloroquine. Nonetheless, dexamethasone has shown promise in symptomatic treatment and convalescent plasma in boosting immunity. New treatments are currently being researched, and the findings will be reported accordingly to provide evidence-based guidance for prescribers and policymakers.