Effectiveness of wearing masks during the COVID-19 outbreak in cohort and case-control studies: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the efficacy of wearing a mask to prevent COVID-19 infection. METHODS: This was a systematic review and meta-analysis of cohort and case-control studies, considering the best level of evidence available. Electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Clinical Trials.gov) were searched to identify studies that evaluated the effectiveness of wearing masks compared with that of not wearing them during the COVID-19 pandemic. Risk of bias and quality of evidence were assessed using the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation. RESULTS: Of the 1,028 studies identified, 9 met the inclusion criteria (2 cohort studies and 7 case-control studies) and were included in the analysis. The meta-analysis using cohort studies alone showed statistically significant differences, wearing a cloth mask decreased by 21% [RD = -0.21 (95% CI, -0.34 to -0.07); I2 = 0%; p = 0,002] the risk of COVID-19 infection, but the quality of evidence was low. Regarding case-control studies, wearing a surgical mask reduced the chance of COVID-19 infection [OR = 0.51 (95% CI, 0.37-0.70); I2 = 47%; p = 0.0001], as did wearing an N95 respirator mask [OR = 0.31 (95% CI, 0.20-0.49); I2 = 0%; p = 0.00001], both with low quality of evidence. CONCLUSIONS: In this systematic review with meta-analysis, we showed the effectiveness of wearing masks in the prevention of SARS-CoV-2 infection regardless of the type of mask (disposable surgical mask, common masks, including cloth masks, or N95 respirators), although the studies evaluated presented with low quality of evidence and important biases.

Effectiveness of wearing masks during the COVID-19 outbreak in cohort and case-control studies: a systematic review and meta-analysis / Eficácia do uso de máscaras durante o surto de COVID-19 em estudos de coorte e caso-controle: uma revisão sistemática e meta-análise

ABSTRACT Objective: To evaluate the efficacy of wearing a mask to prevent COVID-19 infection. Methods: This was a systematic review and meta-analysis of cohort and case-control studies, considering the best level of evidence available. Electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Clinical Trials.gov) were searched to identify studies that evaluated the effectiveness of wearing masks compared with that of not wearing them during the COVID-19 pandemic. Risk of bias and quality of evidence were assessed using the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation. Results: Of the 1,028 studies identified, 9 met the inclusion criteria (2 cohort studies and 7 case-control studies) and were included in the analysis. The meta-analysis using cohort studies alone showed statistically significant differences, wearing a cloth mask decreased by 21% [RD = −0.21 (95% CI, −0.34 to −0.07); I2 = 0%; p = 0,002] the risk of COVID-19 infection, but the quality of evidence was low. Regarding case-control studies, wearing a surgical mask reduced the chance of COVID-19 infection [OR = 0.51 (95% CI, 0.37-0.70); I2 = 47%; p = 0.0001], as did wearing an N95 respirator mask [OR = 0.31 (95% CI, 0.20-0.49); I2 = 0%; p = 0.00001], both with low quality of evidence. Conclusions: In this systematic review with meta-analysis, we showed the effectiveness of wearing masks in the prevention of SARS-CoV-2 infection regardless of the type of mask (disposable surgical mask, common masks, including cloth masks, or N95 respirators), although the studies evaluated presented with low quality of evidence and important biases.

RESUMO Objetivo: Avaliar a eficácia do uso de máscaras na prevenção da infecção por COVID-19. Métodos: Revisão sistemática e meta-análise de estudos de coorte e caso-controle, considerando o melhor nível de evidência disponível. Bancos de dados eletrônicos (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials e ClinicalTrials.gov) foram pesquisados para identificar estudos que avaliassem a eficácia do uso de máscaras em comparação com ausência de seu uso durante a pandemia de COVID-19. O risco de viés e a qualidade da evidência foram avaliados usando a ferramenta Cochrane risk of bias e Grading of Recommendations Assessment, Development, and Evaluation. Resultados: Dos 1.028 estudos identificados, 9 preencheram os critérios de inclusão (2 estudos de coorte e 7 estudos de caso-controle) e foram incluídos na análise. A meta-análise usando apenas estudos de coorte mostrou diferenças estatisticamente significativas: o uso de máscara de tecido diminuiu 21% [(risk difference = −0,21 (IC 95%: −0,34 a −0,07); I2 = 0%; p = 0,002] o risco de infecção por COVID-19, mas a qualidade da evidência foi baixa. Em relação aos estudos caso-controle, o uso de máscara cirúrgica reduziu a chance de infecção por COVID-19 [OR = 0,51 (IC 95%: 0,37-0,70); I2 = 47%; p = 0,0001], assim como o uso de máscara respiratória N95 [OR = 0,31 (IC 95%: 0,20-0,49); I2 = 0%; p = 0,00001], ambos com baixa qualidade de evidência. Conclusões: Nesta revisão sistemática com meta-análise, demonstramos a eficácia do uso de máscaras na prevenção da infecção por SARS-CoV-2 independentemente do tipo de máscara (máscara cirúrgica descartável, máscaras comuns, incluindo máscaras de tecido, ou respiradores N95), embora os estudos avaliados apresentassem evidências de baixa qualidade e vieses importantes.

Use of anticoagulants in patients with COVID-19: a living systematic review and meta-analysis.

OBJECTIVE: To answer questions related to the use of anticoagulants in the treatment of COVID-19 patients. METHODS: This was a systematic review and meta-analysis of phase 3 randomized controlled trials comparing the use of anticoagulants in non-hospitalized and hospitalized COVID-19 patients. We searched the following databases: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from their inception to January 22, 2022. The risk of bias was assessed by the Cochrane risk-of-bias tool, and the quality of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation system. RESULTS: A total of 401 studies were initially selected. Of those, 9 met the inclusion criteria and were therefore analyzed (a total of 6,004 patients being analyzed). In non-hospitalized COVID-19 patients, no significant difference was found between post-discharge prophylactic anticoagulation and no intervention regarding venous thromboembolism or bleeding at 30 days. In hospitalized COVID-19 patients, full anticoagulation resulted in a slight reduction in thrombotic events at 30 days (risk difference, -0.03; 95% CI, -0.06 to -0.00; p = 0.04; I2 = 78%), the quality of evidence being moderate. However, no significant difference was found between full anticoagulation and no intervention regarding the risk of major bleeding, the quality of evidence being very low. No significant difference was found between intermediate- and standard-dose prophylactic anticoagulation (risk difference, -0.01; 95% CI, -0.07 to 0.06; p = 0.81; I2 = 0%), the quality of evidence being very low. CONCLUSIONS: Therapeutic anticoagulation appears to have no effect on mortality in COVID-19 patients, resulting in a slight reduction in venous thromboembolism in hospitalized patients.

Use of remdesivir in patients with COVID-19: a systematic review and meta-analysis.

OBJECTIVE: Studies in the literature regarding the use of remdesivir to treat COVID-19 patients have shown conflicting results. This study sought to answer questions related to the use of remdesivir for the treatment of patients hospitalized with moderate to severe COVID-19. METHODS: This was a systematic review and meta-analysis including phase 3 randomized clinical trials (RCTs) and observational cohort studies selected from various databases, comparing patients hospitalized with moderate to severe COVID-19 receiving remdesivir and controls. RESULTS: A total of 207 studies were retrieved, 9 of which met the eligibility criteria and were included in the study. The meta-analysis using RCTs alone showed no statistically significant differences regarding mortality or use of mechanical ventilation/extracorporeal membrane oxygenation between remdesivir and control groups, and the quality of evidence was moderate and low, respectively. The use of remdesivir increased the recovery rate by 6% (95% CI, 3-9); p = 0.004) and the clinical improvement rate by 7% (95% CI, 1-14); p = 0.02). Additionally, no significant differences in mortality were found between remdesivir and control groups when the meta-analysis used observational cohort studies alone (risk difference = -0.01 (95% CI, -0.02 to 0.01; p = 0.32), the quality of evidence being moderate, and the risk of adverse events was 4% ([95% CI, -0.08 to 0.01]; p = 0.09). CONCLUSIONS: The use of remdesivir for the treatment of patients with moderate to severe COVID-19 had no significant impact on clinically important outcomes.

Use of remdesivir in patients with COVID-19: a systematic review and meta-analysis / Uso de remdesivir em pacientes com COVID-19: revisão sistemática e meta-análise

ABSTRACT Objective: Studies in the literature regarding the use of remdesivir to treat COVID-19 patients have shown conflicting results. This study sought to answer questions related to the use of remdesivir for the treatment of patients hospitalized with moderate to severe COVID-19. Methods: This was a systematic review and meta-analysis including phase 3 randomized clinical trials (RCTs) and observational cohort studies selected from various databases, comparing patients hospitalized with moderate to severe COVID-19 receiving remdesivir and controls. Results: A total of 207 studies were retrieved, 9 of which met the eligibility criteria and were included in the study. The meta-analysis using RCTs alone showed no statistically significant differences regarding mortality or use of mechanical ventilation/extracorporeal membrane oxygenation between remdesivir and control groups, and the quality of evidence was moderate and low, respectively. The use of remdesivir increased the recovery rate by 6% (95% CI, 3-9); p = 0.004) and the clinical improvement rate by 7% (95% CI, 1-14); p = 0.02). Additionally, no significant differences in mortality were found between remdesivir and control groups when the meta-analysis used observational cohort studies alone (risk difference = −0.01 (95% CI, −0.02 to 0.01; p = 0.32), the quality of evidence being moderate, and the risk of adverse events was 4% ([95% CI, −0.08 to 0.01]; p = 0.09). Conclusions: The use of remdesivir for the treatment of patients with moderate to severe COVID-19 had no significant impact on clinically important outcomes.

RESUMO Objetivo: Estudos na literatura sobre o uso de remdesivir no tratamento de pacientes com COVID-19 têm apresentado resultados divergentes. O objetivo deste estudo foi responder a perguntas a respeito do uso de remdesivir no tratamento de pacientes hospitalizados com COVID-19 moderada a grave. Métodos: Trata-se de uma revisão sistemática e meta-análise de ensaios clínicos controlados randomizados (ECR) de fase 3 e estudos observacionais de coorte recuperados de diversos bancos de dados, comparando pacientes hospitalizados com COVID-19 moderada a grave recebendo remdesivir a controles. Resultados: Foram recuperados 207 estudos, dos quais 9 preencheram os critérios de elegibilidade e foram incluídos no estudo. A meta-análise somente dos ECR não mostrou diferenças estatisticamente significativas entre os grupos remdesivir e controle quanto à mortalidade ou ao uso de ventilação mecânica/oxigenação por membrana extracorpórea, e a qualidade das evidências foi moderada e baixa, respectivamente. O uso de remdesivir aumentou a taxa de recuperação em 6% (IC95%: 3-9; p = 0,004) e a taxa de melhora clínica em 7% (IC95%: 1-14; p = 0,02). Além disso, não foram observadas diferenças significativas entre os grupos remdesivir e controle quanto à mortalidade quando a meta-análise concentrou-se apenas nos estudos observacionais de coorte [diferença de risco = −0,01 (IC95%: −0,02 a 0,01); p = 0,32; qualidade das evidências: moderada], e o risco de eventos adversos foi de 4% (IC95%: −0,08 a 0,01; p = 0,09). Conclusões: O uso de remdesivir no tratamento de pacientes com COVID-19 moderada a grave não teve impacto significativo em desfechos clinicamente importantes.

Use of anticoagulants in patients with COVID-19: a living systematic review and meta-analysis / Uso de anticoagulantes em pacientes com COVID-19: revisão sistemática "viva" e meta-análise

ABSTRACT Objective: To answer questions related to the use of anticoagulants in the treatment of COVID-19 patients. Methods: This was a systematic review and meta-analysis of phase 3 randomized controlled trials comparing the use of anticoagulants in non-hospitalized and hospitalized COVID-19 patients. We searched the following databases: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from their inception to January 22, 2022. The risk of bias was assessed by the Cochrane risk-of-bias tool, and the quality of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation system. Results: A total of 401 studies were initially selected. Of those, 9 met the inclusion criteria and were therefore analyzed (a total of 6,004 patients being analyzed). In non-hospitalized COVID-19 patients, no significant difference was found between post-discharge prophylactic anticoagulation and no intervention regarding venous thromboembolism or bleeding at 30 days. In hospitalized COVID-19 patients, full anticoagulation resulted in a slight reduction in thrombotic events at 30 days (risk difference, −0.03; 95% CI, −0.06 to −0.00; p = 0.04; I2 = 78%), the quality of evidence being moderate. However, no significant difference was found between full anticoagulation and no intervention regarding the risk of major bleeding, the quality of evidence being very low. No significant difference was found between intermediate- and standard-dose prophylactic anticoagulation (risk difference, −0.01; 95% CI, −0.07 to 0.06; p = 0.81; I2 = 0%), the quality of evidence being very low. Conclusions: Therapeutic anticoagulation appears to have no effect on mortality in COVID-19 patients, resulting in a slight reduction in venous thromboembolism in hospitalized patients.

RESUMO Objetivo: Responder a perguntas relacionadas ao uso de anticoagulantes no tratamento de pacientes com COVID-19. Métodos: Revisão sistemática e meta-análise de ensaios clínicos controlados randomizados de fase 3 comparando o uso de anticoagulantes em pacientes com COVID-19 não hospitalizados e hospitalizados. Os bancos de dados MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials e ClinicalTrials.gov foram investigados desde sua criação até 22 de janeiro de 2022. O risco de viés foi avaliado pela ferramenta de risco de viés da Cochrane, e a qualidade das evidências foi avaliada pelo sistema Grading of Recommendations Assessment, Development and Evaluation. Resultados: Inicialmente foram selecionados 401 estudos. Destes, 9 preencheram os critérios de inclusão e, portanto, foram analisados (num total de 6.004 pacientes analisados). Em pacientes com COVID-19 não hospitalizados, não se observou diferença significativa entre anticoagulação profilática pós-alta e nenhuma intervenção no que tange a tromboembolismo venoso ou sangramento em 30 dias. Em pacientes com COVID-19 hospitalizados, a anticoagulação plena resultou em ligeira redução de eventos trombóticos em 30 dias (diferença de risco: −0,03; IC95%: −0,06 a −0,00; p = 0,04; I2 = 78%); a qualidade das evidências foi moderada. No entanto, não se observou diferença significativa entre anticoagulação plena e nenhuma intervenção quanto ao risco de sangramento maior; a qualidade das evidências foi muito baixa. Não se observou diferença significativa entre anticoagulação profilática com dose intermediária e dose-padrão (diferença de risco: −0,01; IC95%: −0,07 a 0,06; p = 0,81; I2 = 0%); a qualidade das evidências foi muito baixa. Conclusões: A anticoagulação terapêutica parece não ter efeito na mortalidade em pacientes com COVID-19, resultando em ligeira redução do tromboembolismo venoso em pacientes hospitalizados.

Use of hydroxychloroquine to prevent SARS-CoV-2 infection and treat mild COVID-19: a systematic review and meta-analysis.

OBJECTIVE: Chloroquine or hydroxychloroquine has demonstrated no effect on the treatment of hospitalized COVID-19 patients. This study aimed to answer questions related to the use of hydroxychloroquine for pre-exposure or post-exposure prophylaxis of SARS-CoV-2 infection and in the treatment of patients with mild COVID-19 in terms of hospitalization, adverse events, and mortality. METHODS: This was a systematic review and meta-analysis of phase 3 randomized clinical trials, selected from various databases, which compared patients who received hydroxychloroquine for SARS-CoV-2 prophylaxis or treatment of mild COVID-19 cases with controls. RESULTS: A total number of 1,376 studies were retrieved. Of those, 9 met the eligibility criteria and were included in the study. No statistically significant differences were found between the hydroxychloroquine and control groups in terms of pre- or post-exposure prophylaxis of SARS-CoV-2 infection. The use of hydroxychloroquine increased the risk of adverse events by 12% (95% CI, 6-18%; p < 0.001), and the number needed to harm was 9. In addition, no significant differences were found between the hydroxychloroquine and control groups regarding hospitalization (risk difference [RD] = -0.02; 95% CI, -0.04 to 0.00; p = 0.14) or mortality (RD = 0.00; 95% CI, -0.01 to 0.02; p = 0.98) in the treatment of mild COVID-19. CONCLUSIONS: The use of hydroxychloroquine for prophylaxis of SARS-CoV-2 infection or treatment of patients with mild COVID-19 is not recommended.

Use of hydroxychloroquine to prevent SARS-CoV-2 infection and treat mild COVID-19: a systematic review and meta-analysis / Uso de hidroxicloroquina para prevenir a infecção por SARS-CoV-2 e tratar COVID-19 leve: revisão sistemática e meta-análise

ABSTRACT Objective: Chloroquine or hydroxychloroquine has demonstrated no effect on the treatment of hospitalized COVID-19 patients. This study aimed to answer questions related to the use of hydroxychloroquine for pre-exposure or post-exposure prophylaxis of SARS-CoV-2 infection and in the treatment of patients with mild COVID-19 in terms of hospitalization, adverse events, and mortality. Methods: This was a systematic review and meta-analysis of phase 3 randomized clinical trials, selected from various databases, which compared patients who received hydroxychloroquine for SARS-CoV-2 prophylaxis or treatment of mild COVID-19 cases with controls. Results: A total number of 1,376 studies were retrieved. Of those, 9 met the eligibility criteria and were included in the study. No statistically significant differences were found between the hydroxychloroquine and control groups in terms of pre- or post-exposure prophylaxis of SARS-CoV-2 infection. The use of hydroxychloroquine increased the risk of adverse events by 12% (95% CI, 6-18%; p < 0.001), and the number needed to harm was 9. In addition, no significant differences were found between the hydroxychloroquine and control groups regarding hospitalization (risk difference [RD] = −0.02; 95% CI, −0.04 to 0.00; p = 0.14) or mortality (RD = 0.00; 95% CI, −0.01 to 0.02; p = 0.98) in the treatment of mild COVID-19. Conclusions: The use of hydroxychloroquine for prophylaxis of SARS-CoV-2 infection or treatment of patients with mild COVID-19 is not recommended.

RESUMO Objetivo: A cloroquina ou hidroxicloroquina não apresentou nenhum efeito no tratamento de pacientes hospitalizados com COVID-19. O objetivo deste estudo foi responder a questões a respeito do uso de hidroxicloroquina na profilaxia da infecção por SARS-CoV-2 pré ou pós-exposição e no tratamento de pacientes com COVID-19 leve no tocante à hospitalização, eventos adversos e mortalidade. Métodos: Trata-se de uma revisão sistemática e meta-análise de ensaios clínicos controlados aleatórios de fase 3 que foram selecionados por meio de buscas em diversos bancos de dados e que compararam controles e pacientes que receberam hidroxicloroquina para profilaxia de SARS-CoV-2 ou tratamento de COVID-19 leve. Resultados: Foram identificados 1.376 estudos. Destes, 9 preencheram os critérios de elegibilidade e foram incluídos no estudo. Não foram encontradas diferenças significativas entre os grupos hidroxicloroquina e controle quanto à profilaxia da infecção por SARS-CoV-2 pré ou pós-exposição. O uso de hidroxicloroquina aumentou o risco de eventos adversos em 12% (IC95%: 6-18%; p < 0,001), e o número necessário para prejudicar foi 9. Não foram encontradas diferenças significativas entre os grupos hidroxicloroquina e controle quanto à hospitalização [diferença de risco (DR) = −0,02; IC95%: −0,04 a 0,00; p = 0,14] e mortalidade (DR = 0,00; IC95%: −0,01 a 0,02; p = 0,98) no tratamento de COVID-19 leve. Conclusões: Não é recomendado o uso de hidroxicloroquina nem na profilaxia da infecção por SARS-CoV-2 nem no tratamento de pacientes com COVID-19 leve.