Pharmacological interventions for COVID-19: a systematic review of observational studies and clinical trials

<b>Introduction</b>: Currently, there is no approved therapeutic entity for coronavirus disease 2019 (COVID-19) and clinicians are primarily relying on drug repurposing. However, findings across studies are widely disparate, making it difficult to draw firm conclusions. Since clinicians need accurate evidence to treat COVID-19, this manuscript systematically analyzed the published and ongoing studies evaluating the pharmacological interventions for COVID-19. <b>Areas Covered</b>: A systematic search of observational studies and Clinical Trials on the treatment and prevention of COVID-19 was performed by using various databases from inception to 2 December 2020. <b>Expert Opinion</b>: A total of 460 studies met the inclusion criteria. Of these, 37 were research studies, 386 were ongoing trials, and 37 were completed trials. Anti-virals, steroids, anti-malarial, plasma exchange, and monoclonal antibodies were the most common treatment modalities used alone or in combination in these studies. However, tocilizumab, plasma exchange, and steroids have shown significant improvements in patient’s clinical and radiological status. Tocilizumab reported minimum hospital stay of 2 days along with maximum recovery and patient’s stability rate. Existing literature demonstrate promising results of tocilizumab, plasma exchange, and steroids among COVID-19 patients. Nevertheless, these studies are accompanied by several methodological disparities which should be considered while interpreting the results.

**引言**：目前尚无获批用于新型冠状病毒肺炎（coronavirus disease 2019，COVID-19）的治疗制剂，临床医师主要依赖药物重定位疗法开展诊疗。但各项研究的结果差异悬殊，难以得出确切结论。鉴于临床医师亟需精准可靠的证据以应对COVID-19治疗需求，本研究系统分析了已发表及正在进行的、评估COVID-19药物干预措施的相关研究。
**研究范围**：本研究通过多个数据库，从建库起始至2020年12月2日，系统检索了用于COVID-19治疗与预防的观察性研究（Observational studies）及临床试验（Clinical Trials）。
**专家意见**：最终共有460项研究符合纳入标准。其中37项为已发表研究，386项为正在进行的临床试验，另有37项为已完成的临床试验。抗病毒药物、糖皮质激素、抗疟药、血浆置换及单克隆抗体是此类研究中最常采用的单一或联合治疗手段。然而，托珠单抗（tocilizumab）、血浆置换与糖皮质激素已被证实可显著改善患者的临床及影像学状态。托珠单抗可将患者住院时长最短缩短至2天，同时实现最高的康复率与病情稳定率。现有文献显示，托珠单抗、血浆置换及糖皮质激素对COVID-19患者具有良好的治疗效果。但此类研究存在诸多方法学差异，在解读研究结果时应予以充分考量。