Pharmacological therapies for patients with human coronavirus infections: a rapid systematic review

Abstract This work aimed to evaluate the effects of drug therapies for coronavirus infections. Rapid systematic review with search in the MEDLINE, EMBASE, Cochrane, BVS, Global Index Medicus, Medrix, bioRxiv, Clinicaltrials.gov and International Clinical Trials Registry Platform databases. Thirty-six studies evaluating alternative drugs against SARS, SARS-CoV-2 and MERS were included. Most of the included studies were conducted in China with an observational design for the treatment of COVID-19. The most studied treatments were with antimalarials and antivirals. In antimalarial, the meta-analysis of two studies with 180 participants did not identify the benefit of hydroxychloroquine concerning the negative viral load via real-time polymerase chain reaction, and the use of antivirals compared to standard care was similar regarding outcomes. The available scientific evidence is preliminary and of low methodological quality, which suggests caution when interpreting its results. Research that evaluates comparative efficacy in randomized, controlled clinical trials, with adequate follow-up time and with the methods properly disclosed and subject to scientific peer review is required. A periodic update of this review is recommended.

摘要 本研究旨在评估冠状病毒感染的药物治疗效果。本研究为快速系统综述，检索了MEDLINE、EMBASE、Cochrane、BVS、Global Index Medicus、Medrix、bioRxiv、Clinicaltrials.gov以及国际临床试验注册平台（International Clinical Trials Registry Platform）等数据库。最终纳入36项针对严重急性呼吸综合征（SARS）、严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）和中东呼吸综合征（MERS）的替代治疗药物相关研究。纳入的研究多数在中国开展，且多采用观察性研究设计评估新型冠状病毒肺炎（COVID-19）的治疗方案。本综述中最受关注的治疗手段为抗疟药与抗病毒药物。在抗疟药物相关分析中，针对2项共纳入180名受试者的研究开展的荟萃分析显示，羟氯喹未能通过实时聚合酶链反应（real-time polymerase chain reaction）实现病毒载量转阴的获益；与标准护理方案相比，抗病毒药物治疗的临床结局无显著差异。现有科学证据尚处于初步阶段且方法学质量较低，提示在解读相关研究结果时应保持审慎。亟需开展更多随机对照临床试验以评估药物的对比疗效，此类研究需具备充足的随访时长、完善的方法学披露流程，并经过科学同行评议。本综述建议进行定期更新。