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Several COVID-19 treatments are ineffective in both controlled and observational studies
Clinical Question
Considering both controlled and observational studies, what is the effectiveness of hydroxychloroquine, lopinavir-ritonavir, or dexamethasone for the treatment of COVID-19?
Bottom line
Though the main goal of this analysis was to see how well outcomes from observational and controlled studies lined up, we can use the results for the practical purpose of getting a more complete picture that 3 putative treatment options are, on average, ineffective. These results apply to what I guess we can now call "classic" COVID-19; that is, not the variants more common now. 1a
Reference
Study design: Meta-analysis (other)
Funding: Self-funded or unfunded
Setting: Various (meta-analysis)
Synopsis
These authors assembled and summarized the research on hydroxychloroquine, lopinavir-ritonavir, and dexamethasone cataloged in the National Institutes of Health Covid-19 Treatment Guidelines, ongoing COVID-19 treatment reviews in The BMJ, a living systematic review in PLoS Medicine, and the Epistemonikos Living OVerview of Evidence database through February 2021 (that is, before the evolution of the variants prevalent today). They considered both randomized controlled trials as well as observational trials of the same treatments that evaluated safety and effectiveness (all treatments had at least 2 randomized controlled trials that evaluated their effectiveness) as compared with placebo. Two authors independently selected studies for inclusion, abstracted the data, and evaluated the study quality, excluding retracted research. Pairing up the 46 observational studies (mostly retrospective) with 37 controlled trials showed that treatment effects were similar across both types of studies. Combining all the data, the authors found no reduction of overall mortality with the use of hydroxychloroquine, with or without azithromycin, lopinavir-ritonavir (Kaletra), or dexamethasone. Treatment with hydroxychloroquine did not affect the need for admission, and in-hospital use of hydroxychloroquine or lopinavir-ritonavir did not decrease the need for mechanical ventilation or affect the rate of viral clearance.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
Commonly used drug therapy including HCQ and not very benefi
Authors were convinced thatThe combinationone or more of HCQ,steroids retonavir and Azithromycin in the management of classic Covid 19 did not bring out a palpable change in the need for admission and life support . Ofcourse it is Well received.But ,one can not categorically sideline the fact that the immune mediated inflammatory reaction leading to the need for advanced life support settings was dramatically modified by the timely administration of steroids with other ALS set up.
Dexamethasone
Did you say dex was of no benefit?
we still use dexamethasone routinely in nursing home pts
dexamethasone is an option