Placebo effects on all-cause mortality of patients with COVID-19 in randomized controlled trials of interleukin 6 antagonists: A systematic review and network meta-analysis.
Psychiatry Clin Neurosci
; 77(12): 638-645, 2023 Dec.
Article
in En
| MEDLINE
| ID: mdl-37646204
ABSTRACT
AIM:
Many randomized controlled trials (RCTs) have investigated the use of interleukin 6 antagonists for the treatment of coronavirus disease 2019 (COVID-19), yielding inconsistent results. This network meta-analysis (NMA) aimed to identify the source of these inconsistent results by reassessing whether participants treated with standard of care (SoC) plus placebo have different all-cause mortality from those treated with SoC alone and to reevaluate the efficacy of interleukin 6 antagonists in the treatment of COVID-19.METHODS:
We conducted a systematic search for relevant RCTs from the inception of electronic databases through 1 September 2022. The primary outcome was all-cause mortality. The secondary outcomes were the incidences of major medical events, secondary infections, all-cause discontinuation, and serious adverse events.RESULTS:
The results of NMA of 33 RCTs showed that patients with COVID-19 treated with SoC plus placebo had lower odds of all-cause mortality than those who received SoC alone (OR, 0.75 [95% confidence interval, 0.58-0.97]). This finding remained consistent after excluding studies with no incident deaths. In addition, when we consider the impact of the widely promoted COVID-19 vaccination and newly developed antiviral treatment strategy, the results from the analysis of the RCT published in 2021 and 2022 remained similar.CONCLUSION:
These findings suggest the potential influence of placebo effects on the treatment outcomes of COVID-19 in RCTs. When evaluating the efficacy of treatment strategies for COVID-19, it is crucial to consider the use of placebo in the design of clinical trials.Key words
Full text:
1
Database:
MEDLINE
Main subject:
COVID-19
Type of study:
Clinical_trials
/
Prognostic_studies
/
Systematic_reviews
Limits:
Humans
Language:
En
Journal:
Psychiatry Clin Neurosci
Journal subject:
NEUROLOGIA
/
PSIQUIATRIA
Year:
2023
Type:
Article
Affiliation country:
Taiwan