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A Complementary Critical Appraisal on Systematic Reviews Regarding the Most Efficient Therapeutic Strategies for the Current Covid-19 (Sars-Cov-2) Pandemic Publisher Pubmed



Kheirabadi D1 ; Haddad F2 ; Mousaviroknabadi RS3 ; Rezaeisadrabadi M4 ; Dehghan H5 ; Fazlzadeh A6
Authors
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Authors Affiliations
  1. 1. Department of Anesthesiology and Critical Care, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  2. 2. Department of Medical Physiology, Shiraz University of Medical Sciences, Shiraz, Iran
  3. 3. Department of Emergency Medicine, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, IR, Iran
  4. 4. Department of Internal Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  5. 5. Department of Biostatics, Research Center for Health Technology Assessment and Medical Informatics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
  6. 6. Department of Internal Medicine, Masih Daneshvari hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Source: Journal of Medical Virology Published:2021


Abstract

Background: This critical appraisal aims to clarify which systematic reviews on COVID-19 treatment are based on high-value evidence. Hereby, the most profitable medicines can be suggested. Methods: The mesh terms of COVID-19 drug treatment (Supplementary Concept) and COVID-19 drug treatment were sequentially utilized as search strategies in Medline and Science direct on October 18, 2020. Searches were confined to systematic reviews/meta-analyses. The Cochrane database was searched on November 1, 2020 with COVID. With adding up four articles from other resources, 84 systematic reviews were considered for initial screening. Finally, 22 articles fulfilled the criteria and were assessed using PRISMA guidelines. Results: Increasing number of clinical trials from the onset of the COVID-19 pandemic has revealed that hydroxychloroquine and chloroquine are not only profitable but also deleterious. Lopinavir/ritonavir failed to maintain their initial efficacy in improving clinical symptoms and mortality rate. Steroids and tocilizumab were suggested in patients with intensely severe symptoms. Steroids reduced mechanical ventilation and death in severely ill patients. Plasma or immunoglobulins effects are absolutely controversial. Favorable impressions of remdesivir have been relied on for the early onset of this drug. Hypotension and abnormal liver function tests were realized as its side effects. Favipiravir has resulted in a higher viral clearance than remdesivir. However, this claim needs to be proved with subsequent clinical trials. Conclusions: Currently, remdesivir and favipiravir are advantageous drugs that should be administered in the early phases. Their side effects are not well known and need to be found in the following research projects. Steroids and tocilizumab have been considered beneficial in the cytokine storm phase. © 2021 Wiley Periodicals LLC
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