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Prophylaxis against covid-19: living systematic review and network meta-analysis.
Bartoszko, Jessica J; Siemieniuk, Reed A C; Kum, Elena; Qasim, Anila; Zeraatkar, Dena; Martinez, Juan Pablo Diaz; Azab, Maria; Ibrahim, Sara; Izcovich, Ariel; Soto, Gonzalo Bravo; Roldan, Yetiani; Agarwal, Arnav; Agoritsas, Thomas; Chu, Derek K; Couban, Rachel; Devji, Tahira; Foroutan, Farid; Ghadimi, Maryam; Honarmand, Kimia; Khamis, Assem; Lamontagne, Francois; Loeb, Mark; McLeod, Shelley L; Motaghi, Sharhzad; Murthy, Srinivas; Mustafa, Reem A; Rochwerg, Bram; Switzer, Charlotte; Thabane, Lehana; Vandvik, Per O; Vernooij, Robin W M; Wang, Ying; Yao, Liang; Guyatt, Gordon H; Brignardello-Petersen, Romina.
Afiliação
  • Bartoszko JJ; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
  • Siemieniuk RAC; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
  • Kum E; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
  • Qasim A; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
  • Zeraatkar D; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
  • Martinez JPD; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
  • Azab M; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
  • Ibrahim S; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
  • Izcovich A; Servicio de Clinica Médica del Hospital Alemán, Buenos Aires, Argentina.
  • Soto GB; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
  • Roldan Y; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
  • Agarwal A; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
  • Agoritsas T; Department of Medicine, University of Toronto, Toronto, ON, Canada.
  • Chu DK; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
  • Couban R; Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland.
  • Devji T; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
  • Foroutan F; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Ghadimi M; Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
  • Honarmand K; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
  • Khamis A; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
  • Lamontagne F; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
  • Loeb M; Department of Medicine, Western University, London, ON, Canada.
  • McLeod SL; Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK.
  • Motaghi S; Department of Medicine and Centre de recherche du CHU de Sherbrooke, Sherbrooke, Quebec, Canada.
  • Murthy S; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
  • Mustafa RA; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Rochwerg B; Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada.
  • Switzer C; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
  • Thabane L; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
  • Vandvik PO; Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
  • Vernooij RWM; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
  • Wang Y; Department of Medicine, University of Kansas Medical Center, Kansas City, MO, USA.
  • Yao L; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
  • Guyatt GH; Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • Brignardello-Petersen R; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
BMJ ; 373: n949, 2021 04 26.
Article em En | MEDLINE | ID: mdl-33903131
ABSTRACT
UPDATES This is the second version (first update) of the living systematic review, replacing the previous version (available as a data supplement). When citing this paper please consider adding the version number and date of access for clarity.

OBJECTIVE:

To determine and compare the effects of drug prophylaxis on severe acute respiratory syndrome coronavirus virus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (covid-19).

DESIGN:

Living systematic review and network meta-analysis (NMA). DATA SOURCES World Health Organization covid-19 database, a comprehensive multilingual source of global covid-19 literature to 4 March 2022. STUDY SELECTION Randomised trials in which people at risk of covid-19 were allocated to prophylaxis or no prophylaxis (standard care or placebo). Pairs of reviewers independently screened potentially eligible articles.

METHODS:

After duplicate data abstraction, we conducted random-effects bayesian network meta-analysis. We assessed risk of bias of the included studies using a modification of the Cochrane risk of bias 2.0 tool and assessed the certainty of the evidence using the grading of recommendations assessment, development and evaluation (GRADE) approach.

RESULTS:

The second iteration of this living NMA includes 32 randomised trials which enrolled 25 147 participants and addressed 21 different prophylactic drugs; adding 21 trials (66%), 18 162 participants (75%) and 16 (76%) prophylactic drugs. Of the 16 prophylactic drugs analysed, none provided convincing evidence of a reduction in the risk of laboratory confirmed SARS-CoV-2 infection. For admission to hospital and mortality outcomes, no prophylactic drug proved different than standard care or placebo. Hydroxychloroquine and vitamin C combined with zinc probably increase the risk of adverse effects leading to drug discontinuation­risk difference for hydroxychloroquine (RD) 6 more per 1000 (95% credible interval (CrI) 2 more to 10 more); for vitamin C combined with zinc, RD 69 more per 1000 (47 more to 90 more), moderate certainty evidence.

CONCLUSIONS:

Much of the evidence remains very low certainty and we therefore anticipate future studies evaluating drugs for prophylaxis may change the results for SARS-CoV-2 infection, admission to hospital and mortality outcomes. Both hydroxychloroquine and vitamin C combined with zinc probably increase adverse effects. SYSTEMATIC REVIEW REGISTRATION This review was not registered. The protocol established a priori is included as a supplement.

FUNDING:

This study was supported by the Canadian Institutes of Health Research (grant CIHR-IRSC0579001321).
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Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 1_ASSA2030 / 2_ODS3 / 4_TD / 6_ODS3_enfermedades_notrasmisibles Base de dados: MEDLINE Assunto principal: Ivermectina / Carragenina / Saúde Global / COVID-19 / Hidroxicloroquina Tipo de estudo: Clinical_trials / Systematic_reviews Limite: Humans Idioma: En Revista: BMJ Ano de publicação: 2021 Tipo de documento: Article
Texto completo
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Texto completo: 1 Coleções: 01-internacional Contexto em Saúde: 1_ASSA2030 / 2_ODS3 / 4_TD / 6_ODS3_enfermedades_notrasmisibles Base de dados: MEDLINE Assunto principal: Ivermectina / Carragenina / Saúde Global / COVID-19 / Hidroxicloroquina Tipo de estudo: Clinical_trials / Systematic_reviews Limite: Humans Idioma: En Revista: BMJ Ano de publicação: 2021 Tipo de documento: Article