RESUMO
BACKGROUND@#The global pandemic coronavirus disease 2019 (COVID-19) has become a major public health problem and presents an unprecedented challenge. However, no specific drugs were currently proven. This study aimed to evaluate the comparative efficacy and safety of pharmacological interventions in patients with COVID-19.@*METHODS@#Medline, Embase, the Cochrane Library, and clinicaltrials.gov were searched for randomized controlled trials (RCTs) in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/SARS-CoV. Random-effects network meta-analysis within the Bayesian framework was performed, followed by the Grading of Recommendations Assessment, Development, and Evaluation system assessing the quality of evidence. The primary outcome of interest includes mortality, cure, viral negative conversion, and overall adverse events (OAEs). Odds ratio (OR) with 95% confidence interval (CI) was calculated as the measure of effect size.@*RESULTS@#Sixty-six RCTs with 19,095 patients were included, involving standard of care (SOC), eight different antiviral agents, six different antibiotics, high and low dose chloroquine (CQ_HD, CQ_LD), traditional Chinese medicine (TCM), corticosteroids (COR), and other treatments. Compared with SOC, a significant reduction of mortality was observed for TCM (OR = 0.34, 95% CI: 0.20-0.56, moderate quality) and COR (OR = 0.84, 95% CI: 0.75-0.96, low quality) with improved cure rate (OR = 2.16, 95% CI: 1.60-2.91, low quality for TCM; OR = 1.17, 95% CI: 1.05-1.30, low quality for COR). However, an increased risk of mortality was found for CQ_HD vs. SOC (OR = 3.20, 95% CI: 1.18-8.73, low quality). TCM was associated with decreased risk of OAE (OR = 0.52, 95% CI: 0.38-0.70, very low quality) but CQ_HD (OR = 2.51, 95% CI: 1.20-5.24) and interferons (IFN) (OR = 2.69, 95% CI: 1.02-7.08) vs. SOC with very low quality were associated with an increased risk.@*CONCLUSIONS@#COR and TCM may reduce mortality and increase cure rate with no increased risk of OAEs compared with standard care. CQ_HD might increase the risk of mortality. CQ, IFN, and other antiviral agents could increase the risk of OAEs. The current evidence is generally uncertain with low-quality and further high-quality trials are needed.
Assuntos
Humanos , COVID-19 , Medicina Tradicional Chinesa , Metanálise em Rede , Pandemias , SARS-CoV-2RESUMO
Network Meta-analysis has been widely applied in the field of traditional Chinese medicine(TCM) due to its unique advantages. This study aimed to conduct a visual analysis on the state of the application network Meta-analysis in the field of traditional Chinese medicine. Databases of CNKI and Web of Science were retrieved to identify the qualified literatures and then screen out their titles and abstracts. Institutions, authors, cited references, and keywords were analyzed using the information visualization analysis software CiteSpace. Finally, 79 English and 186 Chinese articles were included. The results indicated that the literatures were mainly published in Chinese, and the number of articles was increased rapidly since 2015. Cooperation between institutions and authors were mainly concentrated inside the institutions. The most important four institutions were four universities who attached more importance to evidence-based medical education and academic exploration. The keywords beside the method of network Meta-analysis could be summarized into three types: the main interventions in traditional Chinese medicine(Chinese herbal injection, herb medicine, acupuncture, etc.), disease types(cancer, circulatory system disease, bone joint disease, urinary system disease, etc.) and the outcome of interests(efficacy, safety, symptom, survive, mortality, etc.), which reflected the current research hotspots to certain extent. In addition, the most cited articles were methodology articles, including the introduction of methodology and the guides of application software, suggesting that the exploration of methodological articles will be extremely concerned.