Rationale and prognosis of repurposed drugs with risk stratification of patients in oxygen support in COVID-19: A systematic review and meta-analysis

Elangovan, E. J.; Kumar, V. S.; Kathiravan, A.; Mallampalli, R.; Thomas, T.; Subramaniyam, G.

There has been rapid development of clinical trials conducted on antivirals, immunomodulators, and other therapies against COVID-19. The rising number of trials has led to duplication and a need for curation of available outcomes from treatments that have been followed across the world. The rising number of trials has led to duplication and a need for curation of available outcomes from treatments that have been followed across the world. We have conducted a systematic review and meta analysis that focus on evaluating the clinical outcomes of repurposed drugs against COVID-19 including Tocilizumab, Remdesivir, Dexamethasome, Lopinavir-ritonavir, Favipiravir, Hydroxychloroquine, and Convalescent plasma therapy. Twenty-nine articles were included in this study after thorough literature search and performed subgroup analyses based on disease severity levels. Random effects model was adopted to estimate overall treatment effect and heterogeneity. Subgroup analysis on mortality rate showed significant overall effect in the treatment group of studies having critically ill patients (p<0.01).Overall, our study confirmed that tocilizumab may probably reduce the mortality (<10%) of patients with COVID-19 with faster recovery time and reduce the risk of patients with lung disease in falling into oxygen support (P = 0.02). Patients on remedesivir showed no significant associations of comorbidities with risk of falling into oxygen supports. Hydroxychloroquine was found to be inefficacious in COVID-19 patients (OR 0.64; 95%CI [0.47-0.86]).Dexamethasone had marginal effect on overall mortality rate (OR 1.19; 95%CI [1.05-1.35]), and hence helpful for patients on mechanical ventilation or ECMO. There was also evidence suggesting that combination therapies (serpin + Favipiravir) were helpful in reducing the mortality rate in COVID-19 patients under invasive support.