Comparative efficacy and safety of anti-infective drugs for patients with mild to severe COVID-19: A systematic review and network meta-analysis of randomized controlled trials

ABSTRACT

Different anti-infecthe drugs have been proposedfor the treatment ofpatients with COVID-19. We carried out a network meta-analysis to assess their relath'e efficacy and safety. Methods: We searched relevant databases for all randomized controlled trials that reported the efficacy and or safety ofany anti-infective drugs published up to April 30, 2022 for different outcomes. We did both painvise and network meta-analysis with 95% confidence intervals using afixed-effect model. We assessed studies for quality of evidence using an extension of the standard Grading ofRecommendations, Assessment, Development and Evaluation approach considering PResults: We included 68 RCTsfor 27,680 participants on 22 anti-infective drugs. For clinical recovery at 14 days Ivermectin (OR 3.00, 95%CI [1.82; 4.96]; p < 0.0001; moderate certainty evidence), Baricitinibplus Remdesh'ir (OR 2.20, 95 0 61 [1.35; 3.53]; p 0.005; 10M' certainty evidence), and Favipiravir (OR 2.16, 95%CI [1.27; 3.68]; p = 0.004; moderate certainty evidence) were statistically effective than standard of care. There was no statistically significant difference between treatments for the viral clearance at 14 days outcome and standard of care. In terms of death outcome, only combined therapy of Baricitinib and Remdesh'ir shoued statistically significant risks of ratio (RR 0.47, 95%CI [0.23; 0.99]; P = 0.03). Arbidol (RR 0.46, 95% CI [0.23; 0.95]; p = 0.04) was statistically safe drug than standard ofcare.

Conclusion:

This Network Meta-analysis suggests that Baricitinib plus Remdesivir is more effective than the other anti-infective drugs in treating patients with COVID-19 in terms of clinical recovery at 14 days, mortality and adverse events outcomes.