Adverse effects of remdesivir, hydroxychloroquine, and lopinavir/ritonavir when used for COVID-19: systematic review and meta-analysis of randomized trials

Background: To summarize specific adverse effects of remdesivir, hydroxychloroquine, and lopinavir/ritonavir in patients with COVID-19.

Methods: We searched 32 databases through 27 October 2020. We included randomized trials comparing any of the drugs of interest to placebo or standard care, or against each other. We conducted fixed-effects pairwise meta-analysis and assessed the certainty of evidence using the GRADE approach.

Results: We included 16 randomized trials which enrolled 8226 patients. For most interventions and outcomes the certainty of the evidence was very low to low except for gastrointestinal adverse effects from hydroxychloroquine, which was moderate certainty. Compared to standard care or placebo, low certainty evidence suggests that remdesivir may not have an important effect on acute kidney injury or cognitive dysfunction/delirium. Low certainty evidence suggests that hydroxychloroquine may increase the risk of cardiac toxicity (and cognitive dysfunction/delir...

背景：旨在总结新型冠状病毒肺炎（COVID-19）患者使用瑞德西韦（remdesivir）、羟氯喹（hydroxychloroquine）以及洛匹那韦/利托那韦（lopinavir/ritonavir）的特异性不良反应。
方法：截至2020年10月27日，我们检索了32个数据库。纳入将目标药物与安慰剂或标准治疗进行对比，或各目标药物间相互比较的随机对照试验。采用固定效应配对Meta分析，并通过GRADE（指南推荐分级的评估、制定与评价）方法评估证据质量。
结果：共纳入16项随机对照试验，累计入组8226例患者。除羟氯喹所致胃肠道不良反应的证据质量为中等外，绝大多数干预措施对应结局的证据质量均为极低至低水平。与标准治疗或安慰剂相比，低质量证据提示瑞德西韦对急性肾损伤或认知功能障碍/谵妄可能无显著影响；低质量证据提示羟氯喹可能会增加心脏毒性（及认知功能障碍/谵……